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Emergency department revisits for patients with kidney stones in California.

Publication ,  Journal Article
Scales, CD; Lin, L; Saigal, CS; Bennett, CJ; Ponce, NA; Mangione, CM; Litwin, MS; NIDDK Urologic Diseases in America Project,
Published in: Acad Emerg Med
April 2015

OBJECTIVES: Kidney stones affect nearly one in 11 persons in the United States, and among those experiencing symptoms, emergency care is common. In this population, little is known about the incidence of and factors associated with repeat emergency department (ED) visits. The objective was to identify associations between potentially mutable factors and the risk of an ED revisit for patients with kidney stones in a large, all-payer cohort. METHODS: This was a retrospective cohort study of all patients in California initially treated and released from EDs for kidney stones between February 2008 and November 2009. A multivariable regression model was created to identify associations between patient-level characteristics, area health care resources, processes of care, and the risk of repeat ED visits. The primary outcome was a second ED visit within 30 days of the initial discharge from emergent care. RESULTS: Among 128,564 patients discharged from emergent care, 13,684 (11%) had at least one additional emergent visit for treatment of their kidney stone. In these patients, nearly one in three required hospitalization or an urgent temporizing procedure at the second visit. On multivariable analysis, the risk of an ED revisit was associated with insurance status (e.g., Medicaid vs. private insurance; odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.43 to 1.61; p < 0.001). Greater access to urologic care was associated with lower odds of an ED revisit (highest quartile OR = 0.88, 95% CI = 0.80 to 0.97; p < 0.01 vs. lowest quartile). In exploratory models, performance of a complete blood count was associated with a decreased odds of revisit (OR = 0.86, 95% CI = 0.75 to 0.97; p = 0.02). CONCLUSIONS: Repeat high-acuity care affects one in nine patients discharged from initial emergent evaluations for kidney stones. Access to urologic care and processes of care are associated with lower risk of repeat emergent encounters. Efforts are indicated to identify preventable causes of ED revisits for kidney stone patients and design interventions to reduce the risk of high-cost, high-acuity, repeat care.

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Published In

Acad Emerg Med

DOI

EISSN

1553-2712

Publication Date

April 2015

Volume

22

Issue

4

Start / End Page

468 / 474

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Risk Factors
  • Retrospective Studies
  • Patient Discharge
  • Odds Ratio
  • Middle Aged
  • Male
  • Kidney Calculi
  • Insurance Coverage
 

Citation

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Scales, C. D., Lin, L., Saigal, C. S., Bennett, C. J., Ponce, N. A., Mangione, C. M., … NIDDK Urologic Diseases in America Project, . (2015). Emergency department revisits for patients with kidney stones in California. Acad Emerg Med, 22(4), 468–474. https://doi.org/10.1111/acem.12632
Scales, Charles D., Li Lin, Christopher S. Saigal, Carol J. Bennett, Ninez A. Ponce, Carol M. Mangione, Mark S. Litwin, and Mark S. NIDDK Urologic Diseases in America Project. “Emergency department revisits for patients with kidney stones in California.Acad Emerg Med 22, no. 4 (April 2015): 468–74. https://doi.org/10.1111/acem.12632.
Scales CD, Lin L, Saigal CS, Bennett CJ, Ponce NA, Mangione CM, et al. Emergency department revisits for patients with kidney stones in California. Acad Emerg Med. 2015 Apr;22(4):468–74.
Scales, Charles D., et al. “Emergency department revisits for patients with kidney stones in California.Acad Emerg Med, vol. 22, no. 4, Apr. 2015, pp. 468–74. Pubmed, doi:10.1111/acem.12632.
Scales CD, Lin L, Saigal CS, Bennett CJ, Ponce NA, Mangione CM, Litwin MS, NIDDK Urologic Diseases in America Project. Emergency department revisits for patients with kidney stones in California. Acad Emerg Med. 2015 Apr;22(4):468–474.
Journal cover image

Published In

Acad Emerg Med

DOI

EISSN

1553-2712

Publication Date

April 2015

Volume

22

Issue

4

Start / End Page

468 / 474

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Risk Factors
  • Retrospective Studies
  • Patient Discharge
  • Odds Ratio
  • Middle Aged
  • Male
  • Kidney Calculi
  • Insurance Coverage