Baumgarten Alex C, Rydberg Michael G, Bates Jenna N, Teigland Chris M, Roy Ornob P
McKay Department of Urology, and Levine Cancer Institute, Carolinas Health Care System, Charlotte, North Carolina.
Urol Pract. 2016 Sep;3(5):325-331. doi: 10.1016/j.urpr.2015.10.005. Epub 2016 Jun 20.
Double-J® ureteral stents are temporary tubes used for ureteral patency that can cause serious complications if left beyond the allotted time. We developed a streamlined framework that allows for Double-J stent tracking to alert patients to the need for removal.
By creating a multidisciplinary committee we developed a database of patients with Double-J stents who presented to our facility between 2012 and 2014. The database was populated by a query of the billing system, generating HIPAA compliant stent removal reminder letters. Three queries (A, B and C) were developed using a combination of billing codes and each query was compared to a gold standard list.
The ICD-9 ureteral catheterization code used to perform query A was only 28% sensitive. Query B (using CPT or HCPCS codes) was 98% sensitive. However, it incorrectly captured many patients with nonureteral stents. Our final query method, query C, rectified this issue by using the ICD-9 code with CPT or HCPCS codes, resulting in the highest sensitivity (78%) while minimizing undesired stent capture.
We developed an automated and reproducible program that correctly identifies and alerts a high percentage of patients to the need to remove their stent. Repeated audits of our query methods combined with regular meetings of a multidisciplinary Double-J stent committee were integral to developing and maintaining this system. By promoting proactive awareness for patients as well as physicians, we are working to minimize the incidence of retained Double-J stents and associated complications.
双J®输尿管支架是用于保持输尿管通畅的临时导管，如果留置时间超过规定期限，可能会引发严重并发症。我们开发了一个简化框架，用于追踪双J支架，以提醒患者需要移除支架。
通过组建一个多学科委员会，我们建立了一个2012年至2014年间在我们机构就诊的双J支架患者数据库。该数据库通过对计费系统进行查询来填充，生成符合《健康保险流通与责任法案》（HIPAA）的支架移除提醒信。使用计费代码组合开发了三个查询（A、B和C），并将每个查询与一个金标准列表进行比较。
用于执行查询A的ICD - 9输尿管插管代码的敏感度仅为28%。查询B（使用CPT或HCPCS代码）的敏感度为98%。然而，它错误地捕获了许多非输尿管支架患者。我们最终的查询方法，即查询C，通过将ICD - 9代码与CPT或HCPCS代码结合使用来纠正了这个问题，从而在将不需要的支架捕获降至最低的同时，实现了最高的敏感度（78%）。
我们开发了一个自动化且可重复的程序，该程序能够正确识别并提醒高比例的患者需要移除其支架。对我们的查询方法进行反复审核，并结合多学科双J支架委员会的定期会议，对于开发和维护该系统至关重要。通过提高患者和医生的主动意识，我们致力于将双J支架留置及相关并发症的发生率降至最低。
