MP46-02 EMERGENCY DEPARTMENT SWITCHING AND DUPLICATE CT SCANS IN PATIENTS WITH KIDNEY STONES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II1 Apr 2016MP46-02 EMERGENCY DEPARTMENT SWITCHING AND DUPLICATE CT SCANS IN PATIENTS WITH KIDNEY STONES Parth K. Shah, MD Phyllis L. Yan, MA J. Stuart Wolf, MD Brent K. Hollenbeck, MD, MS Khurshid R. Ghani, andMD John M. HollingsworthMD, MS Parth K. ShahParth K. Shah More articles by this author , Phyllis L. YanPhyllis L. Yan More articles by this author , J. Stuart WolfJ. Stuart Wolf More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and John M. HollingsworthJohn M. Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.300AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repeated and unnecessary medical imaging is one example of the waste in healthcare spending in the United States. A possible cause for redundant imaging may be lack of information sharing between providers. To test this hypothesis empirically, we analyzed medical claims data from privately insured adults and examined whether emergency department (ED) switching during an acute kidney stone episode was associated with the receipt of a duplicate computed tomography (CT) scan. METHODS We used MarketScan′s Commercial Claims and Encounters Database (2003-2006) to identify adults between the ages 18 and 64 with an ED visit for a physician-coded diagnosis of kidney stones. Next, we assessed whether these patients underwent medical imaging as part of their initial ED evaluation and if so, what type of study they received. Among those with an abdominal/pelvic CT scan, we then determined whether they had an ED revisit within 30 days of their initial ED evaluation, distinguishing between revisits to the same ED or a different one. Finally, we fit a multivariable logistic model to estimate a patient′s odds of receiving a duplicate CT scan based on a revisit to a different ED. RESULTS Over the study interval, we identified 166,639 patients with an ED visit for kidney stones. Eighty-six percent of these patients received some type of medical imaging. CT was the most common study performed; it was used as part of the initial evaluation in 78% of ED visits. 12% of patients who received a CT scan at their initial visit had a revisit within 30 days. One third of these revisits were to a different ED. Patients with revisits to different ED tended to be healthier (P=0.005) and non-salaried (P=0.018), live in more urban areas (P=0.002), and have part-time employment (P<0.001). Duplicate CT scans were obtained at nearly 40% of revisits (Figure 1). On multivariable analysis, a patient′s odds of receiving a duplicate CT were 20% higher (OR, 1.20; 95% CI 1.05-1.38) if his revisit was made to a different ED than the one where he was initially evaluated. CONCLUSIONS Our findings reveal that ED switching during an acute kidney stone episode leads to greater levels of duplicate medical imaging. Our findings support the role of health information exchanges to share medical data across health systems as one way to reduce this waste and the overall cost of healthcare. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e616-e617 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Parth K. Shah More articles by this author Phyllis L. Yan More articles by this author J. Stuart Wolf More articles by this author Brent K. Hollenbeck More articles by this author Khurshid R. Ghani More articles by this author John M. Hollingsworth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...