Quality of Acute Care for Patients With Urinary Stones in the United States.

Journal Article (Journal Article)

OBJECTIVE: To describe guideline adherence for patients with suspected upper tract stones. PATIENTS AND METHODS: We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (emergency department [ED] component) in 2007-2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. RESULTS: An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider, or facility characteristics. CONCLUSION: Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones.

Full Text

Duke Authors

Cited Authors

  • Scales, CD; Bergman, J; Carter, S; Jack, G; Saigal, CS; Litwin, MS; NIDDK Urologic Diseases in America Project,

Published Date

  • November 2015

Published In

Volume / Issue

  • 86 / 5

Start / End Page

  • 914 - 921

PubMed ID

  • 26335495

Pubmed Central ID

  • PMC5453307

Electronic International Standard Serial Number (EISSN)

  • 1527-9995

Digital Object Identifier (DOI)

  • 10.1016/j.urology.2015.07.040


  • eng

Conference Location

  • United States