Nondiagnostic Rate Research Articles

Downward Trends in Bronchoscopies Performed Between 1991 and 1997

To examine the frequency of bronchoscopy performance in a large tertiary medical center over a period of 8 years. Retrospective data analysis. Academic medical center. Using a computerized database of all bronchoscopies performed between 1991 and 1997, we analyzed trends in (1) the total number of bronchoscopies; and (2) the numbers of bronchoscopies performed for patients on the basis of the postbronchoscopic diagnosis in the following three main disease groups: AIDS, interstitial lung disease (ILD), and lung cancer. We measured the following outcomes in the patients of high-volume and low-volume bronchoscopists: procedure length (time to perform procedure), nondiagnostic rate, and repeat-bronchoscopy rate. In addition, we compared total admissions, outpatient visits, and insurance status of the patients during the same period. In total, 5,580 bronchoscopies were performed. A 17% decline in the number of procedures was noted between 1991 and 1997 (from 943 to 783, respectively; p < 0.05). The number of AIDS-related bronchoscopies fell from 235 (25% of 943) to 96 (12% of 783), a 59% decline during this period (p < 0.05). There was a corresponding 76% decrease in the number of bronchoscopies associated with a diagnosis of Pneumocystis carinii pneumonia (PCP; p < 0.05). During the same period, no similar decrease was noted in the number of bronchoscopies associated with a diagnosis of ILD or lung cancer. Moreover, no significant differences were noted in the procedure length, nondiagnostic rate, or repeat-bronchoscopy rate between high-volume and low-volume bronchoscopists. Although there was no significant change in the number of total admissions between 1991 and 1997, there was a 48% increase in the number of managed-care patients and a 25.4% increase in the number of Medicaid health insurance program for California patients between 1991 and 1997. We noted a significant decline in the number of bronchoscopies performed between 1991 and 1997. The significant reduction in the number of AIDS-associated bronchoscopies accounted for 87% of the decline. Other possible factors include the introduction of a management pathway for the empiric treatment of PCP in 1996, a reduction in the number of pulmonary admissions, an increase in the number of managed care patients, and a reduction in the remuneration for the performance of bronchoscopy.

The prevalence of urinary incontinence or prolapse among white and Hispanic women

OBJECTIVE: Our purpose was to study the distribution of symptoms and disorders of urinary incontinence or prolapse among white and Hispanic women. STUDY DESIGN: Data were collected for all new patients referred to the urogynecology clinic over a 2-year period. One hundred twenty-one Hispanic and 50 white women consecutively referred to the urogynecology clinic as new patients over 2 years were included in the study. All patients underwent a detailed history and physical examination and multichannel urodynamic studies. Differences between the two groups were analyzed for significant differences by use of demographic data, presenting symptoms, urodynamic profiles, and final diagnosis or disorder. RESULTS: The symptoms of stress, urge, or mixed incontinence and prolapse were noted in 26%, 18%, 30%, and 14% of white women, respectively, compared with 41%, 9%, 21%, and 26% of Hispanic women ( p = 0019). The diagnosis of genuine stress incontinence, motor urge incontinence, mixed incontinence, and pelvic organ prolapse without incontinence was made, respectively, in 16%, 44%, 6%, and 18% of white women versus 30%, 27%, 5%, and 18% of Hispanic women ( p = 0.33). The nondiagnostic rate after a complete evaluation for both groups was 10%. Hispanic women were of significantly higher gravidity (5.6 vs 3.8, p = 0.001) and parity (4.7 vs 3.0, p = 0.0006) than white women but were of comparable age. Medical problems and medications were too infrequent to allow meaningful comparison. White women were much more likely to have undergone a hysterectomy (36% vs 11.5%, p = 0.0004, 95% confidence interval 1.8 to 10.3). CONCLUSION: Although the distribution of presenting symptoms of incontinence differs between Hispanic and white women, the final diagnosis after a complete urogynecologic evaluation was similar. Therefore presenting complaints in patients of different ethnic groups appears to be a poor predictor of the type of incontinence. Hispanic women were of higher gravidity and parity than white women were, but white women were more likely to have undergone a hysterectomy. Because the power of this study was limited by the 50 white women, larger prospective and longitudinal studies are needed to determine the significance of possible difference in etiologic factors. (A M J O BSTET G YNECOL 1996;174:646-8.)