PURPOSE: Urinary stone disease is a chronic condition for which secondary prevention, in the form of dietary and medical therapy, guided by the results of the 24-hour urine collection, plays an important role.
Assessing response to these interventions with follow-up testing is recommended, yet provider compliance with these guidelines is unknown.
MATERIALS AND METHODS: Using files from the Litholink Corporation® (1995-2013), we identified adult patients with urinary stone disease who underwent metabolic evaluation, as well as the providers who ordered it. Focusing on those patients with an abnormality on their initial collection, we determined the proportion that had a follow-up test within six months of their first. Multilevel modeling was used to quantify variation in follow up testing between providers after accounting for a variety of patient and provider factors.
RESULTS: A total of 208,125 patients had an abnormality on their initial collection and only 33,413 (16.1%) performed a repeat collection within six months. While most of the variation in follow-up testing was attributable to the patient, provider contribution was non-trivial (18.0%). The specialty of the ordering provider was important. Patients who saw an urologist actually had 24% lower odds of having repeated testing when compared to primary care physicians. (OR, 0.76; 95% CI, 0.67 to 0.86; P< 0.001)
CONCLUSION: Follow-up testing in patients with an abnormal initial 24-hour urine collection is uncommon. Given the observed provider variation, efforts to educate providers on the value of follow-up testing are likely to have salutary effects on patients with metabolic stone disease.
Written by:
Dauw CA, Alruwaily AF, Bierlein MJ, Asplin JR, Ghani KR, Wolf JS Jr, Hollingsworth JM. Are you the author?
Divisions of Endourology and Stone Disease and Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan; Litholink, Laboratory Corporation of America®, Holdings®, Chicago, IL.
Reference: J Urol. 2014 Oct 3. pii: S0022-5347(14)04592-3.
doi: 10.1016/j.juro.2014.09.111
PubMed Abstract
PMID: 25286012