San Diego, CA USA (UroToday.com) Economic costs and morbidity of stone disease are increasingly recognized as a population health issue. Improvement lags without common regarding consistent metrics to measure utilization and comparative effectiveness.
Administrative claims (AC) hold potential as an objective metric of utilization but have been criticized because of inherent insensitivity to important stone prognostic factors of size, location, and number. Dr. Andrew Portis and team seek to validate administrative claims with respect to the clinical record, and explore the role and context of AC and medical records.
Their study is a retrospective study that looked at medical records and submitted administrative claims of all stone surgery performed by a single group in 2013. These identified cases were subjected to a 180 day preceding washout period and 120 follow-up period. CPT was rank assigned as PCNL, URSL, or URSN. Index procedures were assigned as the first non-stent procedures, and all data’s validity and reliability were analyzed. Results from the data showed that the index procedures were clinically distinct in stone size, stone location, and stone number. This can serve as a barrier to comparing procedures and effectiveness within a population. Administrative claims are sensitive and specific to procedure type, and to repeat procedures counting from first intervention. Administrative claims are less sensitive to pre-clearance stents and repeat procedures after stone clearance, as well as first procedure as index procedure.
In conclusion, administrative claims are accurate in differentiating procedures and representing medical records, but are challenged by definition of index procedure. This can be mitigated by counting total procedures from first intervention. Overall though, administrative claims are representative of the medical record and can be used to compare between populations. Finally, counting procedures from first intervention will be challenging when stone episode care delivery occurs across multiple institutions.
Presented By: Andrew J. Portis, MD
Written By: Nobel Nguyen, Undergraduate Researcher, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA