Login to Access Video or Poster Abstract: MP95-03
Sources of Funding: AUA Data Grant

Introduction

We have previously demonstrated that outreach centers increase access to urologic procedural care (UPC) in rural settings, but the quality and type of care in these centers has not been explored. Kidney stones affect both sexes of all ages and extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) are the two most common modalities for treating urinary calculi. However, their treatment equivalency has been questioned. The purpose of this study was to assess whether treatment modality patterns differ in outreach centers versus primary center and by patient rurality.

Methods

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. These two databases provide hospital level information on all outpatient procedures performed across the state, by whom they were performed, and whether the hospital represented a primary or outreach center for the urologist. CPT codes for URS (52320, 52325, 52352, 52353) and ESWL (50590) were compared to the type of hospital and the rurality of the patient based on rural-urban commuting area (RUCA) codes. Geographical data was used to analyze travel distances to sites of closest and actual stone treatments for all patients.

Results

During the study period, 21,093 outpatient stone procedures were performed in Iowa (12,007 URS; 9086 ESWL), of which 2932 (13.9%) were performed at outreach centers. Ureteroscopy was significantly more common in primary centers versus outreach centers (60.9% v. 32.1%; OR 3.3; 95% CI 3.0-3.6). Average distance traveled to procedures did not differ significantly between ureteroscopy (31.3 ± 37 miles) and ESWL (25.7 ± 25.7 miles; p = 0.3). Comparing the most rural quartile of rurality as assessed by RUCA coding to the least rural, the likelihood of ESWL was significantly more common in for the rural patients (50.6% vs 37.6; p<0.0001).

Conclusions

Stone and patient characteristics are assumed to be similar in our state&[prime]s rural and urban populations though treatment options and modalities differ widely. Our rural patients were significantly more likely to receive ESWL for their stones and were more likely to receive their care at outreach centers. The clinical and societal significance of this rural disparity is unknown.

Funding

AUA Data Grant