Dauw Casey A, Alruwaily Abdulrahman F, Bierlein Maggie J, Asplin John R, Ghani Khurshid R, Wolf J Stuart, Hollingsworth John M
Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois.
Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America Holdings (JRA), Chicago, Illinois.
J Urol. 2015 Mar;193(3):885-90. doi: 10.1016/j.juro.2014.09.111. Epub 2014 Oct 5.
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.
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.
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).
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.
尿路结石病是一种慢性病，二级预防（根据24小时尿液收集结果进行饮食和药物治疗）在其中起着重要作用。建议通过后续检测评估这些干预措施的效果，但据我们所知，医疗服务提供者对这些指南的依从性尚不清楚。
利用1995年至2013年的Litholink®文件，我们确定了接受代谢评估的尿路结石病成年患者以及开具评估医嘱的医疗服务提供者。通过关注初次收集结果异常的患者，我们确定了在初次检测后6个月内接受后续检测的患者比例。在考虑了各种患者和医疗服务提供者因素后，进行多水平建模以量化医疗服务提供者之间后续检测的差异。
共有208,125名患者初次收集结果异常，其中只有33,413名（16.1%）在6个月内进行了重复收集。虽然后续检测的大部分差异可归因于患者，但医疗服务提供者的影响也不可忽视（18.0%）。开具医嘱的医疗服务提供者的专业很重要。与看初级保健医生的患者相比，看泌尿科医生的患者重复检测的几率低24%（比值比0.76，95%可信区间0.67 - 0.86，p <0.001）。
初次24小时尿液收集结果异常的患者中，后续检测并不常见。鉴于观察到的医疗服务提供者之间的差异，努力对医疗服务提供者进行后续检测价值的教育可能会对代谢性结石病患者产生有益影响。
