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Tytuł:
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Variation in the Intensity of Care for Patients with Uncomplicated Renal Colic Presenting to U.S. Emergency Departments.
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Autorzy:
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Elder JW; Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale-New Haven Hospital, New Haven, Connecticut; Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, Connecticut.
Delgado MK; Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Chung BI; Department of Urology, Stanford University School of Medicine, Stanford, California.
Pirrotta EA; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
Wang NE; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
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Źródło:
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The Journal of emergency medicine [J Emerg Med] 2016 Dec; Vol. 51 (6), pp. 628-635. Date of Electronic Publication: 2016 Oct 05.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: <2010>- : New York : Elsevier
Original Publication: New York : Pergamon Press, c1983-
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MeSH Terms:
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Emergency Service, Hospital*/economics
Hospitalization/*statistics & numerical data
Insurance, Health/*statistics & numerical data
Kidney Calculi/*therapy
Renal Colic/*therapy
Urologic Surgical Procedures/*statistics & numerical data
Adult ; Aged ; Female ; Hospital Charges/statistics & numerical data ; Hospitalization/economics ; Humans ; Kidney Calculi/complications ; Kidney Calculi/economics ; Male ; Medicaid/statistics & numerical data ; Medically Uninsured/statistics & numerical data ; Medicare/statistics & numerical data ; Middle Aged ; Renal Colic/economics ; Renal Colic/etiology ; United States ; Urologic Surgical Procedures/economics ; Young Adult
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Contributed Indexing:
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Keywords: HCUP; Healthcare Cost and Utilization Project; Medicaid; emergency departments; insurance; kidney stones; nephrolithiasis; renal colic; variation
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Entry Date(s):
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Date Created: 20161011 Date Completed: 20171010 Latest Revision: 20180909
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Update Code:
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20240104
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DOI:
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10.1016/j.jemermed.2016.05.037
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PMID:
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27720288
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Background: Renal colic results in > 1 million ED visits per year, yet there exists a gap in understanding how the majority of these visits, namely uncomplicated cases, are managed.
Objective: We assessed patient- and hospital-level variation for emergency department (ED) management of uncomplicated kidney stones.
Methods: We identified ED visits from non-elderly adults (aged 19-79 years) with a primary diagnosis indicating renal stone or colic from the 2011 Nationwide Emergency Department Sample. Patients with additional diagnostic codes indicating infection, sepsis, and abdominal aortic aneurysm were excluded. We used sample-weighted logistic regression to determine the association between hospital admission and having a urologic procedure with patient and hospital characteristics.
Results: Of the 1,061,462 ED visits for uncomplicated kidney stones in 2011, 8.0% of visits resulted in admission and 6.3% resulted in an inpatient urologic procedure. Uninsured patients compared to Medicaid insured patients were less likely to be admitted or have an inpatient urologic procedure (odds ratio [OR] = 0.72; 95% confidence interval [CI] 0.65-0.81 and OR = 0.80; 95% CI 0.72-0.87, respectively). Private- and Medicare-insured patients compared to Medicaid-insured patients were more likely to have an inpatient urologic procedure (OR = 1.20; 95% CI 1.11-1.30 and OR = 1.14; 95% CI 1.04-1.25, respectively).
Conclusions: For patients with uncomplicated renal colic, there is variation in the management associated with nonclinical factors, namely insurance. No consensus guidelines exist yet to address when to admit or utilize inpatient urologic procedures.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
