Departments of Urology and Surgery (JBD), University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
J Urol. 2013 Apr;189(4):1475-80. doi: 10.1016/j.juro.2012.09.122. Epub 2012 Oct 2.
To better understand urological care delivery in rural communities, we evaluated the utilization, outcomes and costs of inpatient urological surgery at critical access hospitals.
Using data from the AHA (American Hospital Association) and NIS (Nationwide Inpatient Sample), we identified all urological surgical admissions to critical and noncritical access hospitals from 2005 through 2009. We compared the distribution of urological procedures, hospital mortality, length of stay and costs for patients undergoing common urological operations at critical vs noncritical access hospitals.
Of the 1,292 critical and 3,760 noncritical access hospitals reporting to the AHA 450 (35%) and 1,372 (36%), respectively, had at least 1 year of data available in the NIS. We identified 333,925 urological surgical admissions, including 2,286 (0.7%) to critical access hospitals. Overall, at least 1 inpatient urological operation was performed at only 45% of critical access hospitals vs 91% of noncritical access hospitals (p <0.001). The distribution of urological surgeries differed between critical and noncritical access hospitals (p <0.001) with a greater prevalence of operations for benign indications at critical access hospitals. For 6 common inpatient urological surgeries we found no meaningful difference in in-hospital mortality and prolonged length of stay between patients treated at critical vs noncritical access hospitals. However, costs at critical access hospitals were universally higher.
Inpatient urological surgery is performed at only a few critical access hospitals. While in-hospital mortality and length of stay are largely indistinguishable between critical and noncritical access hospitals, the higher costs at critical access hospitals may pose a challenge to improving rural access to urological care.
为了更好地了解农村社区的泌尿外科医疗服务提供情况，我们评估了在基层医疗服务指定医院进行住院泌尿外科手术的利用情况、结果和成本。
利用美国医院协会（AHA）和全国住院患者样本（NIS）的数据，我们确定了 2005 年至 2009 年所有基层医疗服务指定医院和非基层医疗服务指定医院进行的泌尿外科手术住院患者。我们比较了基层医疗服务指定医院和非基层医疗服务指定医院进行常见泌尿外科手术的患者的泌尿外科手术分布、医院死亡率、住院时间和费用。
在向 AHA 报告的 1292 家基层医疗服务指定医院和 3760 家非基层医疗服务指定医院中，分别有 450 家（35%）和 1372 家（36%）至少有一年的数据可用于 NIS。我们确定了 333925 例泌尿外科手术住院患者，其中 2286 例（0.7%）入住基层医疗服务指定医院。总体而言，至少进行了一次住院泌尿外科手术的基层医疗服务指定医院比例仅为 45%，而非基层医疗服务指定医院比例为 91%（p<0.001）。基层医疗服务指定医院和非基层医疗服务指定医院的泌尿外科手术分布不同（p<0.001），基层医疗服务指定医院更倾向于进行良性疾病的手术。对于 6 种常见的住院泌尿外科手术，我们发现基层医疗服务指定医院和非基层医疗服务指定医院的住院死亡率和住院时间延长没有明显差异。然而，基层医疗服务指定医院的成本普遍更高。
只有少数基层医疗服务指定医院开展住院泌尿外科手术。虽然基层医疗服务指定医院和非基层医疗服务指定医院的住院死亡率和住院时间延长差异不大，但基层医疗服务指定医院的较高成本可能对改善农村地区获得泌尿外科医疗服务的机会构成挑战。
