MP39-02 OUTCOMES OF HEMATURIA EVALUATION BY ADVANCED PRACTICE PROVIDERS AND UROLOGISTS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP39-02 OUTCOMES OF HEMATURIA EVALUATION BY ADVANCED PRACTICE PROVIDERS AND UROLOGISTS Max J Hyman, Ted Skolarus, Kim Litwack, David Meltzer, and Parth Modi Max J HymanMax J Hyman More articles by this author , Ted SkolarusTed Skolarus More articles by this author , Kim LitwackKim Litwack More articles by this author , David MeltzerDavid Meltzer More articles by this author , and Parth ModiParth Modi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The roles of advanced practice providers (APPs) in surgical practices are growing, but their clinical and financial outcomes are not well understood. We aimed to determine the quality and costs of care to patients initially evaluated for hematuria by urologic APPs rather than urologists. We hypothesized that patients initially evaluated by urologic APPs would receive fewer cystoscopy procedures and imaging studies, have longer waits until cystoscopy and imaging, and have higher out-of-pocket spending and total payments. METHODS: We performed a retrospective cohort study of administrative claims data from 2014-2020. We identified adults with hematuria and an initial outpatient visit with a urologic APP or urologist. We examined receipt of cystoscopy procedure, imaging study, bladder biopsy procedure, and bladder cancer diagnosis within six months of the initial visit. We also evaluated the time until each of these outcomes occurred, and the out-of-pocket (OOP) spending and total payments at three- and six-months after the initial visit. We used multiple logistic and negative binomial regression models, adjusted for beneficiary age, sex, baseline expenditures and comorbidities, location, and insurance details. RESULTS: We identified 59,923 patients (mean age 56.1 years; 51.7% female) who were initially evaluated for hematuria. Visits with urologic nurse practitioners rather than urologists were associated with significantly lower odds of receiving cystoscopy procedures (odds ratio (OR) 0.93, 95% confidence interval (95% CI) 0.54-0.72, p<0.001), imaging studies (OR 0.79, 95% CI 0.69-0.91, p<0.001), and bladder biopsy procedures (OR 0.61, 95% CI 0.41-0.92, p=0.02). Initial visits with urologic physician assistants were associated with 11% greater OOP payments (incident risk ratio (IRR) 1.11, CI 1.01-1.22, p=0.02) and 14% greater total payments (IRR 1.14, CI 1.04-1.25, p=0.004). Initial visits with any urologic APP were associated with longer waits until cystoscopy. There was no difference in the bladder cancer diagnosis rates by provider type. CONCLUSIONS: There are clinical and financial differences in hematuria care delivered by urologic APPs and urologists. The incorporation of APPs into urologic care warrants further study and specialty-specific training for APPs should be considered.Figure 1 Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e534 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max J Hyman More articles by this author Ted Skolarus More articles by this author Kim Litwack More articles by this author David Meltzer More articles by this author Parth Modi More articles by this author Expand All Advertisement PDF downloadLoading ...