Urology Practice最新文献

Introduction: In the Los Angeles County Department of Health Services-the second largest public health care system in the United States-clinical integration allows specialists and primary care providers to collaboratively provide specialty care. We used time-driven activity-based costing to compare patient burden and cost of kidney stone diagnosis, workup, and management with and without clinical integration.

Methods: We interviewed and observed teams of physicians and staff to understand workflow practices and personnel, space, material, and device requirements for stone care in the 2 models. We created process maps that outline the entire arc of care and used time-driven activity-based costing to calculate the all-inclusive costs of kidney stone diagnosis, workup, and scheduling for surgical treatment.

Results: The total cost of kidney stone treatment per stone episode in the integrated pathway was $499.04, compared with $699.81 in the traditional, nonintegrated pathway, a difference of 29%. The number of steps needed to arrive at operating room scheduling was 11 with integration and 14 without it.

Conclusions: Clinical integration resulted in more efficient and cost-effective care from patient, provider, and health system perspectives. Integrated care may improve access to specialty care and increase the value of care and reduce treatment burden on patients.

Introduction: There is increasing awareness that patients with prostate cancer frequently harbor germline variants that may carry important implications for them and their family members. Given the variable clinical guidelines, there remains a need to better understand which patients with prostate cancer are likely to harbor pathogenic or likely pathogenic (P/LP) germline variants. We sought to understand factors associated with P/LP germline variants in patients with metastatic or localized prostate cancer qualifying for National Comprehensive Cancer Network genetic testing criteria.

Methods: Patients diagnosed with prostate cancer were offered genetic testing in accordance with National Comprehensive Cancer Network guidelines. Patient-level factors, including demographic, clinical, and pathologic data, were tracked in a prospectively collected registry. The association of the presence of a P/LP variant in germline testing results with patient-level factors was assessed using univariate and multivariate logistic regression. Variables were tested for overall significance with χ² tests.

Results: Five hundred five patients underwent germline testing and had clinical data available. Rates of P/LP germline variants were 7.6% (20/264) in patients with metastatic disease and 11.2% (27/241) in patients with localized disease. The most prevalent P/LP variants were CHEK2 (34%), BRCA2 (22%), ATM (10%), and HOXB13 (10%).

Conclusions: In this cohort of patients undergoing guideline-informed germline testing, P/LP germline variants were found in similar proportions across all age ranges and clinical characteristics. Only age at genetic testing for patients with metastatic disease was demonstrated to be predictive of the presence of a P/LP germline variant, highlighting the challenges associated with refining current clinical testing guidelines.

Introduction: We conducted a population-based analysis of Fournier gangrene (FG) to compare risk factors and mortality with those of perineal cellulitis.

Methods: We analyzed National Inpatient Sample data (2016-2020) to identify FG and perineal cellulitis cases. Demographic, comorbidity, and procedural data were extracted. Logistic models assessed risk factors of FG diagnosis and mortality.

Results: A total of 73,472 cellulitis and 9326 FG cases were identified corresponding to 74,905 (range, 63,050-79,165) and 9115 (range, 7925-11,080) median yearly weighted cases, respectively. FG diagnosis vs cellulitis was positively associated with Native American race (odds ratio [OR], 1.46; 95% CI, 1.19-1.79), weekend (OR, 1.12; 95% CI, 1.06-1.18) or December (OR, 1.33; 95% CI, 1.22-1.44) admissions, diabetes mellitus (OR, 2.51; 95% CI, 2.38-2.64), and malignancy (OR, 2.29; 95% CI, 2.07-2.54). Conversely, Hispanic (OR, 0.79; 95% CI, 0.74-0.85) and Asian/Pacific Islander races (OR, 0.83; 95% CI, 0.69-0.99) and the highest household income quartile (OR, 0.84; 95% CI, 0.78-0.90) were linked to a reduced likelihood of FG diagnosis. Elevated mortality risks were observed with female sex (OR, 1.33; 95% CI, 1.08-1.63), Native American ethnicity (OR, 2.29; 95% CI, 1.14-4.57), and procedural frequency (OR, 1.27; 95% CI, 1.24-1.3) among FG cases.

Conclusions: Various patient and clinical factors are linked to the development and mortality of FG compared with perineal cellulitis. Improved access to care and understanding of FG can enhance patient outcomes.

Introduction: The aim of this study was to establish the patient-specific cost and time savings associated with telemedicine with the secondary environmental benefits of virtual visits within a tertiary referral center subspecialty urology clinic.

Methods: An electronic health record query was made of all urology telehealth visits that have occurred between April 10, 2020, and October 10, 2020, at a single academic center. We evaluated the cost of travel for an in-person visit based on zip code data. To adjust for productivity loss, the cost of missed work was added as either full-day or half-day-based distance and average compensation per day based on zip code data. Environmental impact was calculated using average CO₂ emissions per mile not traveled.

Results: There were 6444 patients seen in the urology clinic through telehealth during the 6-month period. Urology patients traveled on average 69 ± 148 miles round trip for an appointment. The average cost savings per patient including the cost of gas and time away from work was $152.78 ± $105.90. Overall, over a 6-month period, the total cost savings was $984,534.73 for the 6444 patients seen through telemedicine. There was also a significant environmental impact of the decreased travel burden with 153.36 metric tons of CO₂ emissions eliminated.

Conclusions: With the implementation of telehealth during the COVID-19 pandemic, patients have been able to save a substantial amount of time and money primarily driven by the decreasing work hours lost and cost of travel.