Department of Urology, University of North Carolina at Chapel Hill, POB 170 Manning Dr, CB# 7235, Chapel Hill, NC 27599-7235. Email:
Am J Manag Care. 2023 Nov 1;29(11):e322-e329. doi: 10.37765/ajmc.2023.89458.
Urolithiasis represents a leading cause of emergency department (ED) presentation nationally, affecting approximately 10% of Americans. However, most patients require neither hospital admission nor surgical intervention. This study investigates patient and facility factors associated with potentially avoidable ED visits and their economic consequences.
Retrospective analysis.
Patients presenting to the ED for index urolithiasis events were selected using Florida and New York all-payer data from the 2016 Healthcare Cost and Utilization Project state databases. Avoidable visits were defined as subsequent ED encounters following initial ED presentation that did not result in intervention, admission, or referral to an acute care facility. Utilizing multivariable logistic and linear regression, researchers discerned patient and facility factors predictive of avoidable ED presentations and associated costs.
Of the 167,102 ED encounters for urolithiasis, 7.9% were potentially avoidable, totaling $94,702,972 in potential yearly cost savings. Mean encounter-level costs were higher for unavoidable vs avoidable visits ($5885 vs $2098). In contrast, mean episode-based costs were similar for avoidable and unavoidable episodes ($7200 vs $7284). Receiving care in small metropolitan (vs large metropolitan) communities was associated with potentially avoidable visits, whereas increased comorbidities and Hispanic ethnicity were protective against avoidable visits.
The incidence of ED use for subsequent urolithiasis care reveals opportunity for enhanced outpatient availability to reduce hospital-based costs. Several nonclinical factors are associated with potentially avoidable ED visits for urolithiasis, which, if appropriately targeted, may represent an opportunity to reduce health care spending without compromising the quality of care delivery.
尿路结石是全美急诊科就诊的主要原因之一，影响约 10%的美国人。然而，大多数患者既不需要住院治疗也不需要手术干预。本研究调查了与潜在可避免的急诊科就诊相关的患者和医疗机构因素及其经济后果。
回顾性分析。
使用来自佛罗里达州和纽约州的 2016 年医疗保健成本和利用项目州数据库的所有支付者数据，从急诊科就诊的索引性尿路结石事件患者中选择患者。可避免就诊定义为初始急诊科就诊后再次到急诊科就诊，且未进行干预、住院或转至急性医疗机构。研究人员利用多变量逻辑和线性回归，辨别出可预测潜在可避免急诊科就诊的患者和医疗机构因素及其相关费用。
在 167102 例因尿路结石而就诊的急诊科中，7.9%是潜在可避免的，每年可节省 94702972 美元的潜在费用。不可避免就诊的平均每次就诊费用高于可避免就诊（5885 美元 vs. 2098 美元）。相比之下，可避免和不可避免就诊的平均每例就诊费用相似（7200 美元 vs. 7284 美元）。在小都市（而非大都市）社区接受治疗与潜在可避免就诊有关，而合并症增多和西班牙裔种族则可预防可避免就诊。
因后续尿路结石治疗而就诊的急诊科使用率表明，增加提供门诊服务的机会可以降低基于医院的成本。几个非临床因素与尿路结石的潜在可避免急诊科就诊相关，如果针对这些因素进行适当干预，可能有机会在不影响护理质量的情况下减少医疗支出。
