Predictors and Cost Comparison of Subsequent Urinary Stone Care at Index Versus Non-Index Hospitals.

Journal Article (Journal Article)

OBJECTIVE: To examine the effects of care fragmentation, or the engagement of different health care systems along the continuum of care, on patients with urinary stone disease. METHODS: All-payer data from the 2016 Healthcare Cost and Utilization Project (HCUP) State Databases from Florida (FL) and New York (NY) were used to identify a cohort of adult patients with an emergency department visit for a diagnosis of urolithiasis, who subsequently re-presented to an index or non-index hospital for renal colic and/or urological intervention. Patient demographics, regional data, and procedural information were collected and 30-day episode-based costs were calculated. Multivariable logistic and gamma generalized linear regression were utilized to identify predictors of receiving subsequent care at an index hospital and associated costs, respectively. RESULTS: Of the 33,863 patients who experienced a subsequent encounter related to nephrolithiasis, 9593 (28.3%) received care at a non-index hospital. Receiving subsequent care at the index hospital was associated with fewer acute care encounters prior to surgery (2.5 vs 2.7; P <.001) and less days to surgery (29 vs 42; P < .001). Total episode-based costs were higher in the non-index setting, with a mean difference of $783 (Non-index: $13,672, 95% CI $13,292-$14,053; Index: $12,889, 95% CI $12,677 - $13,102; P < .001). CONCLUSION: Re-presentation to a unique healthcare facility following an initial diagnosis of urolithiasis is associated with a greater number of episode-related health encounters, longer time to definitive surgery, and increased costs.

Full Text

Duke Authors

Cited Authors

  • French, WW; Scales, CD; Viprakasit, DP; Sur, RL; Friedlander, DF

Published Date

  • June 2022

Published In

Volume / Issue

  • 164 /

Start / End Page

  • 124 - 132

PubMed ID

  • 35093397

Electronic International Standard Serial Number (EISSN)

  • 1527-9995

Digital Object Identifier (DOI)

  • 10.1016/j.urology.2022.01.023


  • eng

Conference Location

  • United States