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5.14.11.public health


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5.14.11.public health

  1. 1. EMBARGOED FOR RELEASE UNTIL SATURDAY, MAY 14, 2011 AT 12:30 P.M.Contact: Wendy Waldsachs Isett, AUA410-977-4770, PANEL TO ADDRESS KEY PUBLIC HEALTH CONCERNS IN UROLOGYWashington, DC, May 14, 2011—Patient access to care, the role of telemedicine and quality issues are all keytenets in today’s healthcare debate, and five new studies being presented during the 2011 Annual Meeting of theAmerican Urological Association will provide valuable data that will contribute to the national discussion. A specialpanel press briefing, to be moderated by Tomas L. Griebling, MD, MPH, will be held on Saturday, May 14 at 12:30p.m. to highlight the data from these studies, which include:Urologic Cancer Mortality Rates Stratified by Geographic Region and Physician Prevalence in the United States(#50): Physician density may correlate to ease of care for patients and translate ultimately into worse outcomesfor certain urologic cancers, according to researchers at Tulane University. Using data from the Center for DiseaseControl and Prevention’s (CDC) National Vital Statistics System, study authors examined age-adjusted annualmortality rates for prostate (PCa), bladder (BCa) and renal and pelvis cancers (RCa) from 2003-2007, comparing itwith data from the U.S. Census Bureau that provided key information on the number of physicians, population,health insurance status, poverty level and median family income. Data from the counties with the highestmortality rates for these designated cancers were compared to those with the lowest death rates. Key findingsincluded a significantly higher rate of RCa mortality in areas with low physician density, as well as a negative – andstatistically significant – association between median family income as it relates to BCa and RCa.New Care Coordination System Improves the Quality, Efficiency and Cost of Care for Patients with Hematuria(#314): Patients with blood in their urine (hematuria) may benefit from a care coordination system that helpsensure a complete referral to and evaluation by a urologist in a timely manner that may also result in fewerpatient visits and cost savings overall, according to Northwestern University researchers, who will present astandardized “Hematuria Pathway” checklist to better guide primary care physicians’ assessment and referral ofpatients to urologists. According to the protocol, patients with hematuria should be provided both an order for aCT scan and a urology referral with cystoscopy as they transition from their primary care physician to a urologist(as opposed to receiving the CT order and cystoscopy referral during their initial visit with their urologist). Patientswho were evaluated using this protocol were fully evaluated in a shorter amount of time that those who were not,and were able to complete their urology evaluation in a single visit. Given that an estimated 500,000 to 1 millionhematuria evaluations are performed in the United States each year, removing this initial visit could save anestimated $50 million to $100 million per year, in addition to improving patient access to timely, quality care.Urology Practices and Readiness for Medical Home Reforms (#81): Specialty practices – including urologypractices -- are well positioned to serve as optimal medical homes for some patients, according to a new analysisby researchers at the University of Michigan in Ann Arbor. Using items from the 2007 and 2008 NationalAmbulatory Medical Care Surveys (NAMCS) and specific elements in the National Committee on Quality Assurance(NCQA) medical home standards, researchers examined the structural readiness of specialty practices, awarded
  2. 2. points for each element passed, calculated scores and then estimated the proportion of practices that wouldcurrently achieve medical home status. Estimates were compared for urology vs. other surgical specialties vs.medical specialties. Urology practices outperformed other surgical and medical specialty practices on 10 out of 15elements, including a higher percent of “must pass” elements (45.2 percent vs. 33.7 percent vs. 31.5 percent,respectively). Nearly three quarters of urology practices meet the NCQA standards for medical home recognition,compared to just half of other medical and surgical specialty practices.NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange aninterview with an expert, please contact the AUA Communications Office at the number above or the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the AmericanUrological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughoutthe world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologiccare by carrying out a wide variety of programs for members and their patients. ###
  3. 3. 626THE IMPACT OF OAB ON WORK PRODUCTIVITY IN THE US: RESULTS FROM OAB-POLLChris C. Sexton, Karin S. Coyne, Jill Bell, J. Quentin Clemens, Roger Dmochowski, Chieh-I Chen, Tamara Bavendam,Zoe Kopp, Bethesda, MDINTRODUCTION AND OBJECTIVES: The impact of OAB on work productivity is not well-known. OAB-POLLevaluated OAB and work productivity in a large community sample with an overrepresentation of minorities.METHODS: This cross-sectional, population-representative survey was conducted via the Internet in the US amongmen and women age 18-70 in July and Aug, 2010. The LUTS tool, developed based on ICS definitions andqualitative research, was used to assess the frequency and bother of urinary symptoms during the past 4 weeks ona 5-point Likert scale. OAB was defined by the presence of urinary urgency ? "sometimes" or ? "often" and/or thepresence of urgency urinary incontinence (UUI). Responses of those with OAB were compared to those withno/minimal symptoms (NMS) using descriptive statistics; analyses were conducted among men and womenseparately. Outcomes include work status, the Work Productivity and Activity Impairment Questionnaire-GeneralHealth and Specific Health Problems adapted for urinary symptoms (WPAI-GH/SHP) and a modified version of theWork Limitations Questionnaire (mWLQ). Logistic regressions evaluated predictors of employment status (yes/no)adjusting controlling for demographics, risk factors, and comorbid conditions.RESULTS: Overall response rate was 56.7%; 10,000 men and women participated; mean age was 41.8. Using theOAB ? "sometimes" definition, men and women with NMS were significantly more likely to be currently workingcompared to those with OAB (Men: 76% vs. 57%, women: 59% vs. 45%, p<0.0001). The mean % overall workimpairment due to general health problems was 19% and 21% among men and women with OAB versus 4% inmen and 7% in women with NMS (p<0.0001). Mean % activity impairment due to general health problems: menand women with OAB, 22% and 24%; men and women with NMS, 5% and 7% (p<0.0001). Similar patterns werefound with scores on the WPAI-SHP and mWLQ. Results using the OAB ? "often" definition were similar butreflected greater work impairment. OAB was significantly (p<0.01) associated with being currently unemployedamong men but not women.CONCLUSIONS: Men and women with OAB report significantly greater levels of work limitations as compared tothose without urinary symptoms. Furthermore, mean percentages of overall work impairment from this studywere nearly twice that found in a prior population-based study (EPIC) and were similar to those found in asthma(20%) and rheumatoid arthritis (24%).Source of Funding: Pfizer Inc.
  4. 4. 50UROLOGIC CANCER MORTALITY RATES STRATIFIED BY GEOGRAPHIC REGION AND PHYSICIAN PREVALENCE INTHE UNITED STATESJanet Colli, MD, Leah Grossman, Oliver Sartor, MD, Benjamin R Lee, MD, New Orleans, LA INTRODUCTION AND OBJECTIVES: The risks and benefits of early detection of urologic cancers, especiallyprostate cancer, are controversial. The study purpose is to examine the association between urologic cancermortality rates and the ease of access to medical care correlated to density of physicians. We hypothesize thatcancer mortality rates increase with low populations of physicians among the general public since this woulddecrease access to medical care and reduce screening to identify cancers at an early stage.METHODS: Age-adjusted annual mortality rates for prostate cancer (PCa), bladder cancer (BCa) and renal & pelviscancer (RCa) for Caucasians in U.S. counties from 2003 to 2007 provided by the National Vital Statistics System ofthe Centers for Disease Control and Prevention were obtained for this study. Data on the number of physicians(858,490); population of the general public (290,210,914); the percentage of persons without health insurance;the percentage living below the poverty level and median family income were obtained from the U.S. CensusBureau. High and low cancer rate groups were the formed for the analysis in this study. Counties with the 25highest mortality rates for PCa, BCa and RCa were selected for the high rate group. The low rate group consistedof counties, selected from the same states as the high rate group, with the lowest rates. Population densities ofphysicians per 10,000 general population, and factors related to access to medical care were compared betweenthe high and low groups.RESULTS: Annual High cancer mortality rate group Low cancer mortality rate groupdeaths rates and PCa mortality 47.9 (95% CI = 45.1/50.7) 16.1 (95% CI = 19.0/17.5)the independent Physician population density 11.8 (95% CI = 7.8/15.9) 28.8 (95% CI = 11.7/45.8)variables for the No health insurance 19.0% (95% CI = 16.3/21.5) 17.6% (95% CI =15.1/20.0)high and lowPoverty 12.6% (95% CI = 10.7/14.5) 10.2% (95% CI = 9.1/11.3)cancer mortality income ($) Family $41,137 (95% CI=$38,144/44,131) $46,177 (95% CI=$43,392/48,961)rate groups are mortality BCa 8.6 (95% CI = 8.3/9.0) 3.6 (95% CI = 3.4/3.8)provided in thePhysician population density 17.1 (95% CI = 11.7/22.4) 33.3 (95% CI = 21.5/45.1)Table below.No health insurance (%) 18.8 (95% CI = 16.9/20.7) 18.4 (95% CI = 16.6/20.2)(Statistically Poverty (%) 12.1(95% CI = 10.4/13.9) 10.2 (95% CI = 8.2/12.2)significant Family income ($) $42,664 (95% CI=$39,809/45,519) $49,733 (95% CI = $45,596/53,870)differences RCa mortality 8.5 (95% CI = 8.1/8.9) 3.4 (95% CI = 3.2/3.6)between groups Physician population density 14.0 (95% CI=10.0/18.1) 42.2 (95% CI=24.1/60.3)are in bold.) No health insurance (%) 17.7 (95% CI = 15.2/20.1) 17.7 (95% CI = 15.4/20.0) Poverty (%) 12.4 (95% CI = 10.5/14.3) 9.9 (95% CI = 8.2/11.7) Family income ($) $42,515 (95% CO=$39,340/45689) $53,350 (95% CI= $48,747/57,953CONCLUSIONS: RCa cancer mortality rates are increased significantly with low population density of physiciansamong the general public. This potentially is a result of decreased access to medical care and reduced testing todiagnose RCa at an early stage. We found a suggestive but not significant negative association between theprevalence of physicians and mortality rates for PCa and BCa. There was also a negative association betweenmedian family income that was statistically significant for BCa and RCa and suggestive for PCa.Source of Funding: None
  5. 5. 314NEW CARE COORDINATION SYSTEM IMPROVES THE QUALITY, EFFICIENCY AND COST OF CARE FOR PATIENTSWITH HEMATURIAJessica T. Casey, John Cashy, Amy Tourne-Schwab, Nilmini Wickramasinghe, Anthony J. Schaeffer, Christopher M.Gonzalez, Lyle L. Berkowitz, Chicago, ILINTRODUCTION AND OBJECTIVES: As microscopic and gross hematuria are common urologic referrals with adefined best practice pathway for evaluation, we sought to determine if inclusion of a care coordination system tomanage the referral process would lead to improved quality, efficiency and economic outcomes.METHODS: A care coordination system was developed which included the primary care physician?s use of astandardized ?Hematuria Pathway? checklist which included orders for a CT scan followed by a urology referralwith cystoscopy. A care coordinator facilitated the ordering process and reviewed the progress at 4 weeks toensure completion. This system was used for patients referred for hematuria from May 2009 to May 2010. Theoutcomes for these ?navigated? patients (group A, n=106) were compared to patients referred to our urologydepartment for hematuria during the same time period who did not use a care coordination system (group B,n=105).RESULTS: Demographics, presenting symptoms, and final diagnoses were equal between groups, and there was nosignificant difference in the percentage of patients who completed the entire hematuria work-up (55.7% A vs.47.6% B, p=0.24) or were seen by urology (84.0% A vs. 77.1% B, p=0.21). However, patients in group A completedtheir evaluation in significantly shorter times with decreased time between the diagnosis of hematuria andcompletion of the CT scan (22.0 vs. 45.2 days, p<0.05) and completion of cystoscopy (35.8 vs. 70.6 days, p<0.05).Additionally, more patients in group A had their CT scan completed prior to their first urology visit (75.5% vs.28.6%, p<0.05). Also, group A had more patients who completed their evaluation in one urology visit (56.6% vs.21.9%, p<0.05).CONCLUSIONS: Incorporating a care coordination system into the referral process for hematuria decreased thetime to complete evaluation. Timeliness, one of the Institute of Medicine?s quality metrics, is particularlyimportant for this situation as 3.8% of patients had a new cancer diagnosis. Additionally, increasing the number ofCT scans done prior to the first urology visit resulted in less total urology visits per evaluation. This finding shouldresult in decreased cost to patients and payors, as well as increased access to care for others as moreappointments will be open. It is estimated there are 500,000 to 1,000,000 hematuria evaluations per year in theU.S., so removing an initial visit with a cost of $100 could save the healthcare system approximately $50 to $100million per year. Further analysis of the economic and quality ramifications of this care coordination system isunder way.Source of Funding: Szollosi Healthcare Innovation Program, Grant Healthcare Foundation
  6. 6. 81UROLOGY PRACTICES AND READINESS FOR MEDICAL HOME REFORMSJohn M. Hollingsworth, Joseph W. Sakshaug, David C. Miller, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: The degree to which existing physician practices possess the ?structuralreadiness? to function as medical homes has been incompletely examined. Prior evaluations have focused mainlyon primary care practices. As there are certain conditions for which specialty practices might be the optimalmedical home (e.g., urology practices for men with prostate cancer), there is also a need to better understand thecurrent infrastructure in these settings.METHODS: We mapped items from the 2007 and 2008 National Ambulatory Medical Care Surveys (NAMCS) tospecific elements in the National Committee on Quality Assurance (NCQA) standards for medical homerecognition. We awarded points to a practice for each NCQA element that it passed. We then calculated apractice?s ?structural readiness? score by dividing its point total by the available number. Finally, we estimatedthe proportion of physician practices that would achieve medical home status according to clinical specialty (i.e.,urology versus other surgical specialty versus medical specialty).RESULTS: Urology practices outperformed other surgical and medical specialty practices on ten of 15 measuredelements. Moreover, urology practices achieved a higher percent of ?must pass? elements (45.2% versus 33.7versus 31.5%, respectively; P<0.001). Nearly three quarters of urology practices meet current NCQA standards formedical home recognition, as compared to just half of other surgical and medical specialty practices (Table).CONCLUSIONS: Our findings indicate that the majority of urology practices possess the ?structural readiness? forimplementation of proposed medical home reforms.Source of Funding: Robert Wood Johnson Foundation Clinical Scholars Program