MP32-20 TAKING THE PROCEDURE TO THE PATIENT: INCREASING ACCESS TO UROLOGIC PROCEDURAL CARE THROUGH OUTREACH

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness IV1 Apr 2015MP32-20 TAKING THE PROCEDURE TO THE PATIENT: INCREASING ACCESS TO UROLOGIC PROCEDURAL CARE THROUGH OUTREACH Matthew Uhlman, Thomas Gruca, and Bradley Erickson Matthew UhlmanMatthew Uhlman More articles by this author , Thomas GrucaThomas Gruca More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1416AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have previously shown that urologic outreach clinics significantly increase access to urologic clinical care in rural populations. How these clinics affect access to procedural care is unknown. The purpose of this study was to analyze the use of outreach facilities for urologic procedural care (UPC) in a rural state. We hypothesized that outreach UPC would be primarily low acuity, diagnostic procedures. METHODS We analyzed provider level data from urology practices within Iowa using information from (1) the Office of Statewide Clinical Educations Programs (OSCEP) and (2) the Iowa Hospital Association (IHA) database. Using data from 2010-2013, provider information from OSCEP, which identifies each physician in the state of Iowa's home office and their satellite offices, was cross-referenced with IHA procedural data. UPC that was performed by the urologists at their outreach centers was categorized based on CPT codes by the type of procedure performed (open, endoscopic, laparoscopy, non-invasive (e.g. ESWL, urodynamics) and the intention of the procedure (therapeutic vs diagnostic). Overall outreach UPC volume was then compared to UPC at non-outreach centers over the study period. RESULTS A total of 11026 urologic procedures were performed at outreach clinics, accounting for 14.4% of all UPC in the state. The yearly number of outreach procedures remained stable during the study period, but decreased as a percentage of all procedures (15% in 2010 to 13% in 2013). The majority (55%) of procedures were therapeutic in nature, most commonly transurethral resection procedures (16%), stent procedures (16%) and ESWL (10%). Most procedures (64%) were endoscopic, while only 8.3% of all UPC involved making an incision, of which the most common were circumcision (28%), hydrocele (19%), orchiectomy (10%), suburethral sling (8%), suprapubic tube placement (7%) and vasectomy (7%). More ESWL procedures (600) were performed than ureteroscopies (373) for stone disease. CONCLUSIONS A large percentage of the total UPC in our state was done at outreach clinics, and while the vast majority was of low acuity, a majority was therapeutic. It is unclear why the number of outreach procedures remained flat during the study period, but it may suggest current centers are operating near capacity and new ones are reluctant to expand given the lack of knowledge regarding UPC at such locations. Changes in healthcare economics are projected to affect rural hospitals, which rely on procedural care the most, and our study is the first to show the role UPC can play in such locations. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e372 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Uhlman More articles by this author Thomas Gruca More articles by this author Bradley Erickson More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...