Association of Patient and Visit Characteristics With Rate and Timing of Urologic Procedures for Patients Discharged From the Emergency Department With Renal Colic | Emergency Medicine | JAMA Network Open | JAMA Network
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    Original Investigation
    Emergency Medicine
    December 2, 2019

    Association of Patient and Visit Characteristics With Rate and Timing of Urologic Procedures for Patients Discharged From the Emergency Department With Renal Colic

    Author Affiliations
    • 1Department of Emergency Medicine, University of Massachusetts Medical School–Baystate, Springfield
    • 2Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School–Baystate, Springfield
    • 3School of Public Health and Health Sciences, University of Massachusetts, Amherst
    • 4Duke Clinical Research Institute, Division of Urologic Surgery, Duke University School of Medicine, Durham, North Carolina
    • 5Department of Medicine, University of Massachusetts Medical School–Baystate, Springfield
    • 6Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
    JAMA Netw Open. 2019;2(12):e1916454. doi:10.1001/jamanetworkopen.2019.16454
    Key Points español 中文 (chinese)

    Question  When an adult patient is discharged from the emergency department after an episode of renal colic, what is their likelihood of having a urologic procedure within the next 60 days?

    Findings  In this cohort study of 66 218 unique index visits by 55 314 patients 18 to 64 years of age, 5.0% of patients underwent a urologic procedure by 7 days and 12.7% underwent a urologic procedure by 60 days. Patients with Medicaid were less likely to undergo urologic procedures.

    Meaning  These findings may inform emergency department–based shared decision-making about imaging options and outpatient follow-up for patients younger than 65 years.

    Abstract

    Importance  Little is known about the timing of urologic interventions in patients with renal colic discharged from the emergency department. Understanding patients’ likelihood of a subsequent urologic intervention could inform decision-making in this population.

    Objectives  To examine the rate and timing of urologic procedures performed after an emergency department visit for renal colic and the factors associated with receipt of an intervention.

    Design, Setting, and Participants  This retrospective cohort study used the Massachusetts All Payers Claims Database to identify patients 18 to 64 years of age who were seen in a Massachusetts emergency department for renal colic from January 1, 2011, to October 31, 2014, Patients were identified via International Classification of Diseases, Ninth Revision codes, and all medical care was linked, enabling identification of subsequent health care use. Data analysis was performed from January 1, 2017, to December 31, 2018.

    Main Outcomes and Measures  The main outcome was receipt of urologic procedure within 60 days. Secondary outcomes included rates of return emergency department visit and urologic and primary care follow-up.

    Results  A total of 66 218 unique index visits by 55 314 patients (mean [SD] age, 42.6 [12.4] years; 33 590 [50.7%] female; 25 411 [38.4%] Medicaid insured) were included in the study. A total of 5851 patients (8.8%) had visits resulting in admission at the index encounter, and 1774 (2.7%) had visits resulting in a urologic procedure during that admission. Of the 60 367 patient visits resulting in discharge from the emergency department, 3018 (5.0%) led to a urologic procedure within 7 days, 4407 (7.3%) within 14 days, 5916 (9.8%) within 28 days, and 7667 (12.7%) within 60 days. A total of 3226 visits (5.3%) led to a subsequent emergency department visit within 7 days and 6792 (11.3%) within 60 days. For the entire cohort (admitted and discharged patients), 39 189 (59.2%) had contact with a urologist or primary care practitioner within 60 days. Having Medicaid-only insurance was associated with lower rates of urologic procedures (odds ratio, 0.70; 95% CI, 0.66-0.74) and urologic follow-up (5.6% vs 8.8%; P < .001) and higher rates of primary care follow-up (59.2% vs 47.2%; P < .001) compared with patients with all other insurance types.

    Conclusions and Relevance  In this cohort study, most adult patients younger than 65 years who were discharged from the emergency department with a diagnosis of renal colic did not undergo a procedure or see a urologist within 60 days. This finding has implications for both the emergency department and outpatient treatment of these patients.

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