Stout Megan, Mcnamara Molly, Posid Tasha, Scimeca Alicia, Khuhro Aliza, Murtha Matthew, Yudovich Max, Diab Dinah, Shidham Ganesh, Weinandy Elizabeth, Knudsen Bodo E, Sourial Michael W
Department of Urology and The Ohio State Wexner Medical Center, Columbus, Ohio, USA.
The Ohio State University College of Medicine, Columbus, Ohio, USA.
J Endourol. 2023 Apr;37(4):467-473. doi: 10.1089/end.2022.0564. Epub 2022 Dec 28.
There is a call to improve Medicaid patient access to health care, enhance quality and outcomes of care, and reduce overall financial burden. We sought to build a comprehensive kidney stone program to help patients navigate through the acute and preventive aspects of stone disease by increasing multidisciplinary referrals and compliance with recommendations and decreasing no-show rates at first follow-up and repeat stone encounters after initial evaluation. A collaborative multidisciplinary program was established at our single institution consisting of urology, nephrology, and dietary specialists to be piloted over a 3-year period. Medicaid-designated patients were evaluated during new patient encounters by urology specialists and then followed for outpatient follow-up, including specialty referrals to nephrology specialists and dietitians, for targeted preventive measures. Subjective compliance reports by patients following interventions and no-show rates at subsequent follow-ups were documented. We also followed patients 6 months beyond the initial encounter to assess repeat Emergency Department (ED) visits for acute stone episodes. One hundred eighty-three Medicaid-designated stone patients were evaluated from 2018 to 2021. Sixty-eight percent of patients identified as White, 18% identified as Black/African American, and 14% identified as "Other." Patients underwent specialty referrals to nephrology or a dietician in 47% and 42% of cases, respectively. Since the program's implementation, reported patient compliance and referrals to multidisciplinary specialists increased from 72.9% to 81.30% and 21.2% to 56.20%, respectively. Repeat ED visits for stone-related encounters within 6 months of initial presentation remained relatively stable (from 17.60% to 18.9%), while no-show rates at first follow-up decreased from 20.0% to 6.30% by study conclusion. There is continued supporting evidence for the importance of a comprehensive kidney stone program specifically for patients of lower socioeconomic status following a 3-year implementation at our institution. Encouraging results indicate increased access to multidisciplinary specialty referrals, with improvement in follow-up and reported compliance related to stone prevention strategies.
