PD48-02 CARING FOR ADULTS WITH CONGENITAL GENITOURINARY ANOMALIES: ADULT UROLOGY DEPARTMENT LEADERS' PERSPECTIVES ON PROGRAMMATIC CHANGE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Transitional Urology & GU Congenitalism1 Apr 2018PD48-02 CARING FOR ADULTS WITH CONGENITAL GENITOURINARY ANOMALIES: ADULT UROLOGY DEPARTMENT LEADERS' PERSPECTIVES ON PROGRAMMATIC CHANGE Briony Varda, Carlos Estrada, Caleb Nelson, and Erin McNamara Briony VardaBriony Varda More articles by this author , Carlos EstradaCarlos Estrada More articles by this author , Caleb NelsonCaleb Nelson More articles by this author , and Erin McNamaraErin McNamara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2306AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transitional and longitudinal multidisciplinary care models for adults with congenital genitourinary anomalies (CGA) are lacking. Prior research has studied various causes, but no studies have focused on the concerns of department leaders, who are central to supporting and promoting new programs. This study sought their perspectives to better understand a) the perceived role of adult programs in caring for CGA patients, and b) the barriers and facilitators to developing comprehensive care for this population. METHODS We conducted semi-structured interviews with adult urology chairs/division chiefs. Criterion-type sampling was used to create a heterogeneous sample reflecting programs of varying sizes and pediatric affiliations. An interview guide was created and iteratively revised via 5 pilot interviews. We used a framework approach (a systematic methodology often used in qualitative healthcare research) for analysis. This approach includes: 1) immersion with the data (reading of transcripts, explicit coding, and group discussions of emerging themes), 2) independent closed-coding using a code book based on emerging themes and research aims, and 3) a final interpretation of the data by evaluating coding reports to identify convergence, divergence and variation in themes, as well as contextual meaning and connotation. RESULTS Of 45 contacted, 20 leaders participated. There was wide variation regarding the perceived role of caring for CGA patients, ranging from episodic care by individual providers to comprehensive multidisciplinary care led by a urology team. Barriers related to cost prevailed, in particular the financial risk of taking on a population perceived to have high resource utilization with low compensation. This was often compounded by a lack of provider capacity and/or difficulty obtaining support from academic/hospital entities. Although the risk of unfavorable quality metrics was noted, this was ascribed nominal importance. Only 3 participants had established care models for patients with CGA, but intentions to develop programs were common. Motivated pediatric and adult providers were clear facilitators. There was a general sense of duty to care for the CGA population, and an educational value was widely noted. CONCLUSIONS Among adult urology program leaders, opinions vary regarding their programs' role in managing CGA patients with considerable concerns related to the cost of comprehensive care models. Our results highlight the need for strategic program development to overcome these barriers. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e961 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Briony Varda More articles by this author Carlos Estrada More articles by this author Caleb Nelson More articles by this author Erin McNamara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...