Urology Practice最新文献

Introduction: We aimed to characterize patient portal messaging use after urologic surgery to identify administrative burden and evaluate postoperative clinical associations.

Methods: Epic was queried for all urologic surgeries performed at the Mayo Clinic enterprise between 2019 and 2022. Data from the highest volume procedures were extracted including patient-generated portal messages to their provider and emergency department (ED) visits within 6 months of surgery. Factors associated with portal users and message volume, as well as the impact of portal use on risk of subsequent ED visit, were evaluated.

Results: We analyzed data from 23,621 urologic procedures, which generated 102,726 patient portal messages within 6 months of surgery. We found that 55% of our cohort sent at least 1 message. Stratifying by subspecialty, endourologic surgeries generated the fewest number of messages per surgery (3.83; SD, 8.76), whereas female pelvic medicine and reconstructive surgeries yielded the most (6.05; SD, 10.92). Younger age, female sex, and White race were associated with increased portal utilization. Multivariable time-to-event analysis revealed a 33% reduction in the risk of ED presentation within 90 days after surgery for patients using the patient portal compared with those who did not.

Conclusions: While only half of patients sent portal messages after surgery, active users showed a 33% reduction in ED visits, suggesting its potential to reduce health care utilization. Encouraging broader portal adoption can improve outcomes. However, the message burden for urologists necessitates solutions. Resource allocation should prioritize strategies to help urologists manage messages while preserving the established clinical benefits.

Introduction: We sought to implement a multipronged behavioral intervention to reduce and tailor antibiotic use for 2 common urologic outpatient procedures.

Methods: This study was a nonblinded intervention study that consisted of a preintervention phase (November 2018-January 2019), an intervention phase (January 2020-December 2020) in which a multipronged behavioral intervention was implemented, and a postintervention phase (January 2021-March 2021). We examined antibiotic use for cystoscopy and transrectal prostate biopsy at 3 separate urologic outpatient clinics. A multipronged behavioral intervention consisted of formal physician education, modification of the electronic health order sets, clinic staff education, literature review, development and introduction of patient questionnaires, and individual audit feedback. The primary outcome was 30-day infections. Secondary outcomes were adherence to the recommended antibiotic protocols, questionnaire completion, and Escherichia coli outpatient antibiograms.

Results: A total of 2374 patients underwent 3047 cystoscopies, and 547 patients underwent 559 prostate biopsies. The proportions of cystoscopy patients receiving antibiotic prophylaxis and prostate biopsy patients receiving augmented antibiotic prophylaxis decreased 33% and 35%, respectively. The odds of postcystoscopy infection were not different between the preintervention and intervention phases and were lower in the postintervention phase. The odds of postbiopsy infection were not changed between the preintervention and intervention phases or between the preintervention and postintervention phases.

Conclusions: Implementing a multipronged behavioral intervention reduced and tailored antibiotic use without an increase in 30-day infections. These findings suggest that outpatient antibiotic stewardship and facilitating rapid adoption of guidelines can be accomplished via this approach.

Introduction: Patient-centered communication after surgery can enhance patient satisfaction and reduce unplanned clinical contact. However, patient information needs following kidney stone surgery are not well understood, limiting quality improvement efforts. We aimed to characterize patient-reported needs in and preferences for postoperative communication following kidney stone surgery.

Methods: Patients undergoing common stone procedures were surveyed about the content, volume, and satisfaction with the communication they received after surgery. Patients indicated which information resources they consulted and found most helpful to address their postoperative care questions.

Results: Among 52 patients, the majority (75%) identified varying degrees of deficiencies in the communication they received after surgery. Regarding content, respondents were most interested in understanding how their surgery went (90%), the plan for follow-up care (85%), and the specific location of their stone (85%). Regarding volume, respondents consistently indicated interest in intraoperative findings (stone appearance and location) and postoperative care (stent symptoms and location) but the majority did not recall receiving enough information. To address their questions after surgery, respondents most commonly consulted their urologist (71%), discharge paperwork (42%), electronic health record (27%), and the person with whom their urologist spoke after surgery (25%); among these, the majority (54%) reported that their urologist was the single most helpful source of information.

Conclusions: Following kidney stone surgery, patients report unmet communication needs related to specific intraoperative findings and follow-up care. Patients indicate high levels of satisfaction with urologist-provided resources. These exploratory findings support quality improvement efforts to optimize delivery of effective, patient-centered communication after surgery.

Introduction: The aim of this study was to identify preoperative patient/facility factors associated with postoperative and total episode-related costs using renal colic as a model surgical condition to improve value-based payment models.

Methods: Using state Healthcare Cost and Utilization Project data, we performed a retrospective cohort study examining perioperative costs for individuals presenting to an emergency department for renal colic and who ultimately underwent definitive surgical management. We estimated multivariable ordered and binary logistic regressions to examine the association between preoperative and operative cost quartiles on the probability of specific postoperative cost quartiles after accounting for hospital and individual factors. We also performed logistic regressions to identify patients who deviated from predicted perioperative cost pathways.

Results: Among 2736 individuals included in our analysis, episode-related costs ranged from $4536 (bottom quartile) to $26,662 (top quartile). Individuals in the highest preoperative cost quartile experienced an 11.7% higher probability of remaining in the highest postoperative cost quartile relative to those in the lowest preoperative cost quartile (95% CI, 0.0709-0.163; P < .001). Delays in surgery (95% CI, 0.0869-0.163; P < .001) and Medicaid vs private insurance (95% CI, 0.01-0.0728; P < .01) were associated with a 12.5% and 4.1% higher probability of being in the top quartile of preoperative costs, respectively. Treating facility experience with value-based payment models did not influence perioperative costs.

Conclusions: Using renal colic as a model surgical condition, our novel findings suggest that preoperative costs are associated with both postoperative and total episode-related costs and should be accounted for when designing future value-based payment models.

Introduction: Black males have the highest incidence and mortality rates from prostate cancer of any racial group in the United States, yet are underrepresented in prostate cancer clinical trials.

Methods: The Prostate Health Education Network surveyed its members about experiences regarding prostate cancer clinical trials and explored reasons for lack of participation. Black males residing in the United States with a diagnosis of prostate cancer were eligible to participate.

Results: Of 480 members contacted, 115 (24.0%) completed the survey. Respondents were diverse in age, geography, education, and socioeconomic status, and 58 (50.4%) had a family history of prostate cancer; 12 of 115 (10.4%) had participated in a prostate cancer clinical trial. The most common reasons for nonparticipation (N = 89) included not being asked (55.1%) and a lack of information about risks and benefits (13.5%). No respondents cited lack of trust in the healthcare system based on personal experience, although 2 (2.2%) cited the Tuskegee study. Factors that would influence future decisions around trial participation included whether respondents (N = 99) perceived the treatment or diagnostic option to be effective for themselves (54.5%), to have the potential to advance medical science (45.5%), and to have minimal side effects (44.4%).

Conclusions: This survey of Prostate Health Education Network members found that the principal reason for Black males not participating in prostate cancer clinical trials was that they were not being asked. This highlights an unmet need for stronger collaboration between patients, health professionals, the pharmaceutical industry, and clinical trial investigators to address barriers to Black males enrolling in prostate cancer clinical trials.