Provider variation in the quality of metabolic stone management.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE
    • Publication Information:
      Publication: 2019- : [Philadelphia, PA] : Wolters Kluwer
      Original Publication: Baltimore : Lippincott Williams & Wilkins
    • Subject Terms:
      Practice Patterns, Physicians'*; Urinalysis/*standards ; Urinalysis/*statistics & numerical data ; Urinary Calculi/*therapy ; Urinary Calculi/*urine; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Guideline Adherence ; Humans ; Male ; Middle Aged ; Primary Health Care ; Urinary Calculi/metabolism ; Urology ; Young Adult
    • Abstract:
      Purpose: Urinary stone disease is a chronic condition for which secondary prevention (dietary and medical therapy guided by 24-hour urine collection results) has an important role. Assessing the response to these interventions with followup testing is recommended and yet to our knowledge provider compliance with these guidelines is unknown.
      Materials and Methods: Using Litholink® files from 1995 to 2013 we identified adults with urinary stone disease who underwent metabolic evaluation and the providers who ordered the evaluation. By focusing on patients with an abnormality on the initial collection we determined the proportion who underwent a followup test within 6 months of the initial test. Multilevel modeling was done to quantify variation in followup testing among providers after accounting for various patient and provider factors.
      Results: A total of 208,125 patients had an abnormality on the initial collection, of whom only 33,413 (16.1%) performed a repeat collection within 6 months. While most variation in followup testing was attributable to the patient, the provider contribution was nontrivial (18.0%). The specialty of the ordering provider was important. Patients who saw a urologist had 24% lower odds of repeat testing compared to those who saw a primary care physician (OR 0.76, 95% CI 0.67-0.86, p <0.001).
      Conclusions: Followup testing is uncommon in patients with an abnormal initial 24-hour urine collection. Given the observed provider variation, efforts to educate providers on the value of followup testing are likely to have salutary effects on patients with metabolic stone disease.
      (Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
    • Grant Information:
      K08 HS020927 United States HS AHRQ HHS; 1K08HS020927-01A1 United States HS AHRQ HHS
    • Contributed Indexing:
      Keywords: chronic disease; physician's practice patterns; standards; urinalysis; urinary calculi
    • Publication Date:
      Date Created: 20141007 Date Completed: 20150930 Latest Revision: 20211021
    • Publication Date:
      20221213
    • Accession Number:
      10.1016/j.juro.2014.09.111
    • Accession Number:
      25286012