For a study, researchers sought to determine the impact of care fragmentation, or the involvement of several health care systems along the continuum of treatment, on patients with urinary stone disease.
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 who presented to an index or non-index hospital for renal colic and/or urological intervention following an emergency department visit for a diagnosis of urolithiasis. Patient demographics, geographical data, and procedure details were gathered, and 30-day episode-based expenses were determined. To identify determinants of obtaining further care at an index hospital and related expenses, multivariable logistic regression and gamma generalized linear regression were used, respectively.
About 9,593 (28.3%) of the 33,863 patients who had a later contact due to nephrolithiasis were treated in a non-index hospital. Following care at the index hospital was related with fewer acute care visits prior to surgery (2.5 vs 2.7; P<.001) and fewer days to surgery (29 vs 42; P<.001). The non-index option had higher total episode-based expenditures, with a $783 mean difference (Non-index: $13,672, 95% CI $13,292-$14,053; Index: $12,889, 95% CI $12,677 – $13,102; P<.001).
Following an initial diagnosis of urolithiasis, re-presentation to a specific healthcare institution was linked with an increased number of episode-related health contacts, a longer time to definitive surgery, and increased expenses.