Geographic Variation in the Quality of Secondary Prevention for Nephrolithiasis

Abdulrahman F Alruwaily; Casey A Dauw; Maggie J Bierlein; John R Asplin; Khurshid R Ghani; J Stuart Wolf Jr; John M Hollingsworth

doi:10.1016/j.urology.2015.05.022

Geographic Variation in the Quality of Secondary Prevention for Nephrolithiasis

Urology. 2015 Sep;86(3):454-8. doi: 10.1016/j.urology.2015.05.022. Epub 2015 Jun 11.

Authors

Abdulrahman F Alruwaily¹, Casey A Dauw², Maggie J Bierlein², John R Asplin³, Khurshid R Ghani², J Stuart Wolf Jr², John M Hollingsworth⁴

Affiliations

¹ Divisions of Endourology and Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Department of Surgery, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia.
² Divisions of Endourology and Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
³ Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, IL.
⁴ Divisions of Endourology and Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: kinks@med.umich.edu.

PMID: 26210006
DOI: 10.1016/j.urology.2015.05.022

Abstract

Objective: To examine the variation in the quality of secondary prevention for nephrolithiasis across health care markets.

Methods: Using analytical files from Litholink Corporation (2003-2012), we identified adults with nephrolithiasis and abnormal urine biochemistries on 24-hour urine collection. After assigning all patients to a hospital referral region (HRR), we determined the proportion of patients in each HRR who underwent on-treatment follow-up testing (our measure of quality). We then fitted multivariate hierarchical regression models to quantify the amount of variation in this proportion across HRRs. Finally, we examined for associations between a patient's odds of on-treatment follow-up testing and the supply of primary care and specialist physicians in an HRR.

Results: The mean rate on-treatment follow-up testing was exceedingly low at only 11.9%. This rate has been stable over time. There was fourfold variation in this rate across HRRs from as little as 6.6% to as high as 23.4%. Those HRRs with higher on-treatment follow-up testing rates tended to have a wealthier and more educated population (P = .01). Receipt of on-treatment follow-up testing was not associated with the number of specialists per capita.

Conclusion: Wide geographic variation exists in the quality of secondary prevention for patients with nephrolithiasis. Given that current guidelines recommend on-treatment follow-up testing, efforts to increase its uptake are needed.

Published by Elsevier Inc.

MeSH terms

Adult
Catchment Area, Health*
Health Services Accessibility / organization & administration*
Humans
Nephrolithiasis / diagnosis*
Nephrolithiasis / prevention & control*
Quality of Health Care*
Regression Analysis
Secondary Care / organization & administration*
Socioeconomic Factors
United States