Abstract: FR-PO246
Facility-Level Variation in Nephrology Care among Veterans after Urinary Stone Events
Session Information
- Mineral Bone Disease: Transplant and Kidney Stones
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Thomas, Kaleb, Stanford Medicine, Stanford, California, United States
- Ganesan, Calyani, Stanford Medicine, Stanford, California, United States
- Liu, Sai, Stanford Medicine, Stanford, California, United States
- Montez-Rath, Maria E., Stanford Medicine, Stanford, California, United States
- Soerensen, Simon John Christoph, Stanford Medicine, Stanford, California, United States
- Leppert, John, Stanford Medicine, Stanford, California, United States
- Pao, Alan C., Stanford Medicine, Stanford, California, United States
Background
Nephrologists are uniquely qualified to manage recurrent urinary stone disease. The objective of this study was to determine the frequency of nephrology visits after a urinary stone event, a key window of opportunity to assess stone risk.
Methods
We used nationwide data from the United States Veterans Health Administration to identify patients who had an incident stone event between 2016 and 2018. We defined a stone event as having an (index) inpatient or outpatient stone diagnosis code followed by an additional stone diagnosis or procedure code within 6 months of the index diagnosis. We examined the proportion of patients who visited a nephrology clinic within 6 months of a stone event.
Results
We identified 45,133 Veterans who had an incident urinary stone event. Within six months of the stone event, only 5.6% of patients visited nephrology if they did not have a prior nephrology visit; whereas 70% of patients visited nephrology if they had a prior nephrology before the stone event. Veterans who had a lower eGFR were more likely to see a nephrologist after a stone event (for patients who visited nephrology previously OR 2.28, 95% 2.01-2.58; for patients who had not visited nephrology previously OR 5.19, 95% 4.69-5.74). The median odds ratio for a nephrology follow-up visit was 1.51 for patients who had a past nephrology visit, whereas the median odds ratio was higher for patients who did not have a past nephrology visit (1.74). Figure 1 shows the proportion of patients who saw a nephrologist after their stone event across 104 sites.
Conclusion
Nephrologists are infrequently and variably involved in the care of patients with urinary stone disease, suggesting potential for quality improvement.
Funding
- Veterans Affairs Support