Charles D Scales1, Jonathan Bergman2, Stacey Carter3, Gregory Jack3, Christopher S Saigal4, Mark S Litwin5. 1. Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles, CA; U.S. Department of Veterans Affairs, Greater Los Angeles Health Care System, Los Angeles, CA; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA. Electronic address: Chuck.scales@duke.edu. 2. Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles, CA; U.S. Department of Veterans Affairs, Greater Los Angeles Health Care System, Los Angeles, CA; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA. 3. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA. 4. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; RAND Corporation, Santa Monica, CA. 5. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; RAND Corporation, Santa Monica, CA; Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, CA.
Abstract
OBJECTIVE: To describe guideline adherence for patients with suspected upper tract stones. PATIENTS AND METHODS: We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (emergency department [ED] component) in 2007-2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. RESULTS: An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider, or facility characteristics. CONCLUSION: Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones. Published by Elsevier Inc.
OBJECTIVE: To describe guideline adherence for patients with suspected upper tract stones. PATIENTS AND METHODS: We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (emergency department [ED] component) in 2007-2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. RESULTS: An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider, or facility characteristics. CONCLUSION: Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones. Published by Elsevier Inc.
Authors: Kiriaki K Stamatelou; Mildred E Francis; Camille A Jones; Leroy M Nyberg; Gary C Curhan Journal: Kidney Int Date: 2003-05 Impact factor: 10.612
Authors: Charles D Scales; Li Lin; Christopher S Saigal; Carol J Bennett; Ninez A Ponce; Carol M Mangione; Mark S Litwin Journal: Acad Emerg Med Date: 2015-03-16 Impact factor: 3.451
Authors: Michael N Ferrandino; Aditya Bagrodia; Sean A Pierre; Charles D Scales; Edward Rampersaud; Margaret S Pearle; Glenn M Preminger Journal: J Urol Date: 2008-12-18 Impact factor: 7.450
Authors: Jonathan S Ellison; Paul A Merguerian; Benjamin C Fu; Sarah K Holt; Thomas S Lendvay; John L Gore; Margarett Shnorhavorian Journal: J Pediatr Urol Date: 2017-04-20 Impact factor: 1.830
Authors: Andrew C Meltzer; Pamela Katzen Burrows; Allan B Wolfson; Judd E Hollander; Michael Kurz; Ziya Kirkali; John W Kusek; Patrick Mufarrij; Stephen V Jackman; Jeremy Brown Journal: JAMA Intern Med Date: 2018-08-01 Impact factor: 21.873
Authors: Elizabeth M Schoenfeld; Meng-Shiou Shieh; Penelope S Pekow; Charles D Scales; James M Munger; Peter K Lindenauer Journal: JAMA Netw Open Date: 2019-12-02