1 Department of Urology, UCSF Medical Center, San Francisco, California.
2 Department of Medicine, and UCSF Medical Center, San Francisco, California.
J Endourol. 2019 Jan;33(1):9-15. doi: 10.1089/end.2018.0776. Epub 2018 Dec 31.
To explore regional adoption of ureteroscopy (URS) over extracorporeal shockwave lithotripsy (SWL) in the state of California (CA) and to identify factors associated with this adoption over time.
We used the California Office of Statewide Health Planning and Development (OSHPD) public data to identify URS and SWL procedures performed for renal and ureteral stones from 2005 to 2016. The level of analysis was the region wherein each procedure was performed, defined by the 19 CA labor market regions. OSHPD data were supplemented with the Area Health Resource File to provide information on regional characteristics. Generalized linear regression was used to determine procedural rates adjusted for age, gender and race. Choropleth time series maps were used to illustrate adoption of URS by region over time.
A total of 328,795 URS and SWL procedures were identified from 2005 to 2016. The number of URS procedures surpassed the number of SWL procedures in 2011. Fourteen regions became URS predominant by 2016 and were characterized as having a higher per capita income, higher percentages with a college education and lower percentage of female heads-of-household (all p-values <0.05). A higher percentage of patients in these regions were male and had private or Medicare insurance (p = 0.03 for both).
From 2005 to 2016, most CA regions adopted URS as the primary renal and ureteral stone management strategy. These regions demonstrated characteristics of higher socioeconomic status compared to regions that remained SWL predominant. A better understanding of such differences in practice patterns will allow urologists to better negotiate for the capital expenditures required to conform to evolving standards of care and allow patients the ability to make more informed decisions on where they receive care.
探讨加利福尼亚州（CA）内输尿管镜检查术（URS）相对于体外冲击波碎石术（SWL）的区域性应用，并确定随着时间的推移与这种应用相关的因素。
我们使用加利福尼亚州卫生规划和发展办公室（OSHPD）的公共数据，从 2005 年至 2016 年，确定了用于治疗肾结石和输尿管结石的 URS 和 SWL 手术。分析的水平是每个手术进行的区域，由 CA 的 19 个劳动力市场区域定义。OSHPD 数据辅以区域卫生资源文件，提供了有关区域特征的信息。使用广义线性回归来确定调整年龄、性别和种族后的手术率。使用专题时间序列图来说明随着时间的推移，各区域对 URS 的采用情况。
2005 年至 2016 年间，共确定了 328795 例 URS 和 SWL 手术。2011 年，URS 手术数量超过了 SWL 手术数量。到 2016 年，有 14 个区域成为 URS 为主导的区域，其特点是人均收入较高，具有大学学历的比例较高，女性户主的比例较低（所有 p 值均<0.05）。这些地区的患者中，男性比例较高，拥有私人或医疗保险（两者均为 p<0.03）。
从 2005 年到 2016 年，CA 的大多数地区采用 URS 作为治疗肾结石和输尿管结石的主要策略。与仍以 SWL 为主导的地区相比，这些地区具有更高的社会经济地位特征。更好地了解这些实践模式方面的差异，将使泌尿科医生能够更好地协商所需的资本支出，以符合不断发展的护理标准，并使患者能够更明智地决定在何处接受治疗。
