Department of Urology, Geisinger Health System, Danville, Pennsylvania; Department of Health Services Research and Epidemiology, Geisinger Health System, Danville, Pennsylvania.
Biostatistics Core, Geisinger Health System, Danville, Pennsylvania.
J Urol. 2018 Feb;199(2):543-550. doi: 10.1016/j.juro.2017.08.005. Epub 2017 Aug 5.
We describe age, multiple chronic condition profiles and health system contact in patients with urological cancer.
Using Geisinger Health System electronic health records we identified adult primary care patients and a subset with at least 1 urology encounter between 2001 and 2015. The Agency for Health Care Research and Quality Chronic Condition Indicator and Clinical Classifications Software tools were applied to ICD-9 codes to identify chronic conditions. Multiple chronic conditions were defined as 2 or more chronic conditions. Patients with urological cancer were identified using ICD-9 codes for prostate, bladder, kidney, testis and penile cancer. Inpatient and outpatient visits in the year prior to the most recent encounter were counted to document health system contact.
We identified 357,100 primary care and 33,079 urology patients, of whom 4,023 had urological cancer. Patients with urological cancer were older than primary care patients (71 vs 46 years) and they had more median chronic conditions (7 vs 4). Kidney and bladder cancer were the most common chronic conditions (median 8 patients each). Coronary artery disease and chronic kidney disease were common in urological cancer cases compared to mental health conditions in primary care cases. Patients with urological cancer who had multiple chronic conditions had the most health system contact, including 32% with at least 1 hospitalization and 68% with more than 5 outpatient visits during 1 year.
Urology patients are older and more medically complex, especially those with urological cancer than primary care patients. These data may inform care redesign to reduce the treatment burden and improve care coordination in urological cancer cases.
我们描述了患有泌尿系统癌症患者的年龄、多种慢性疾病状况和医疗系统接触情况。
我们使用 Geisinger 健康系统电子健康记录，确定了成年初级保健患者和至少有 1 次 2001 年至 2015 年期间泌尿科就诊的亚组患者。应用医疗保险和医疗补助服务中心慢性疾病指标和临床分类软件工具对 ICD-9 代码进行分析，以确定慢性疾病。多种慢性疾病定义为 2 种或更多慢性疾病。使用 ICD-9 代码对前列腺癌、膀胱癌、肾癌、睾丸癌和阴茎癌患者进行识别。记录在最近就诊前一年中住院和门诊就诊次数，以了解医疗系统接触情况。
我们确定了 357100 名初级保健患者和 33079 名泌尿科患者，其中 4023 名患有泌尿系统癌症。患有泌尿系统癌症的患者比初级保健患者年龄更大（71 岁比 46 岁），且中位数慢性疾病更多（7 种比 4 种）。肾脏和膀胱癌是最常见的慢性疾病（中位数为每位患者 8 例）。与初级保健患者的心理健康状况相比，泌尿系统癌症患者更常见冠状动脉疾病和慢性肾病。患有泌尿系统癌症且患有多种慢性疾病的患者接受了最多的医疗系统接触，包括 32%至少有 1 次住院治疗和 68%有超过 5 次门诊就诊。
泌尿科患者比初级保健患者年龄更大，且病情更复杂，特别是患有泌尿系统癌症的患者。这些数据可能有助于重新设计护理方案，减轻治疗负担并改善泌尿系统癌症患者的护理协调。
