Treatment Setting Influences Treatment Modality for Urinary Stone Disease.

To determine whether selection of treatment modality for urinary stone disease differs between primary and outreach healthcare centers, and if patient rurality predicts treatment modality.

We retrospectively evaluated ESWL and URS procedural data from the Iowa Office of Statewide Clinical Education Programs (OSCEP) and Iowa Hospital Association (IHA) databases from 2007-2014. Geographical data was used to analyze travel metrics and patient proximity to sites of stone treatment. Rural-urban commuting area (RUCA) codes were used to characterize patient rurality. Chi-square tests and t-tests were used to compare ESWL and URS patients, and multilevel logistic regression model was used to assess influence of treatment setting on surgical modality.

18,831 stone procedures were performed by urologists in Iowa on patients from Iowa (10,495 URS; 8,336 ESWL). 2,630 procedures occurred at outreach centers. Ureteroscopy comprised 59.7% of procedures at primary centers, but only 31.2% at outreach centers. On multilevel analysis, outreach location was associated with 2.236 OR towards ESWL (p<0.001). Individual physician treatment patterns accounted for 32% of treatment variation. Patient rurality was not significantly associated with treatment modality as an independent factor (p=0.879).

Wide variation exists in urolithiasis treatment modality selection between outreach and primary centers. Outreach locations perform a significantly higher frequency of ESWL compared to URS, and much of the variation in treatment selection (32%) arises from individual physician practice patterns.

Urology. 2020 May 24 [Epub ahead of print]

Charles J Paul, Thomas S Gruca, Paul G Morrison, George M Ghareeb, Sang Hee Kim, Bradley A Erickson

University of Iowa Hospitals & Clinics, Department of Urology, Iowa City, IA., University of Iowa, Tippie College of Business, Iowa City, IA., United Regional Physician Group, Wichita Falls, TX., Emory University, Department of Urology, Atlanta, GA., University of Iowa Hospitals & Clinics, Department of Urology, Iowa City, IA. Electronic address: .