Tag: statistics

Urol Pract. 2022 Sep;9(5):379-388. doi: 10.1097/UPJ.0000000000000327. Epub 2022 Jul 5.

ABSTRACT

INTRODUCTION: Chaperones are often employed during sensitive patient encounters and have been assumed to be mutually beneficial to the patient and provider. The aim of this study is to characterize patient preferences regarding the use of chaperones.

METHODS: Following Institutional Review Board Approval, a questionnaire designed to evaluate preferences regarding chaperone use from a patient perspective was distributed electronically through the ResearchMatch platform as well as to patients in an outpatient urology clinic. Descriptive statistics were used to assess responder demographics, clinical experiences and preferences. Multiple regression analysis was used to determine factors associated with a preference for having a chaperone present during health care visits.

RESULTS: A total of 913 individuals completed the survey. Over half (52.9%) reported they would not want a chaperone for any part of a health care visit. Although rectal and genital/pelvic examinations were considered sensitive by 76.3% and 85% of responders, respectively, only 25.4% and 15.7% preferred a chaperone during these encounters. Reasons for not wanting a chaperone included trust in the provider (80%) and comfort with examinations (70.4%). Male responders were less likely to report a preference for a chaperone (OR 0.28, 95% CI 0.19-0.39) or consider provider gender as a significant factor in preferring a chaperone (OR 0.28, 95% CI 0.09-0.66).

CONCLUSIONS: Preference regarding the use of a chaperone is primarily influenced by gender of both the patient and the provider. For sensitive examinations commonly performed in the field of urology, most individuals would not prefer a chaperone be present.

PMID:37145728 | DOI:10.1097/UPJ.0000000000000327

Urol Pract. 2022 Sep;9(5):474-480. doi: 10.1097/UPJ.0000000000000317. Epub 2022 Aug 22.

ABSTRACT

INTRODUCTION: COVID-19 has forever impacted health care in the U.S. Changes to health and hospital policies led to disruptions to both patient care and medical training. There is limited understanding of the impact on urology resident training across the U.S. Our aim was to examine trends in urological procedures, as captured by the Accreditation Council for Graduate Medical Education resident case logs, throughout the COVID-19 pandemic.

METHODS: Retrospective review of publicly available urology resident case logs between July 2015 and June 2021 was performed. Average case numbers were analyzed via linear regression with different models specifying different assumptions regarding the impact of COVID-19 on procedure in 2020 and onward. Statistical calculations utilized R (version 4.0.2).

RESULTS: Analysis favored models which assumed the impact of COVID-related disruptions were specific to 2019-2020. Analysis of procedures performed indicate an average upward trend of urology cases nationally. An average annual increase of 26 procedures between 2016 and 2021 was noted, except for 2020 which saw an average drop of approximately 67 cases. However, in 2021 case volume dramatically increased to the same rate as projected had there not been a disruption in 2020. Stratifying by category of urology procedure revealed evidence for variability between categories in the magnitude of the 2020 decrease.

CONCLUSIONS: Despite widespread pandemic-related disruptions in surgical care, urological volume has rebounded and increased, likely having minimal detriment to urological training over time. Urological care is essential and in high demand as evidenced by the uptick in volume across the U.S.

PMID:37145725 | DOI:10.1097/UPJ.0000000000000317

Urol Pract. 2022 Sep;9(5):481-490. doi: 10.1097/UPJ.0000000000000311. Epub 2022 Jun 1.

ABSTRACT

INTRODUCTION: There is a shortage in the number of urologists needed to satisfy the needs of an aging U.S.

POPULATION: The urologist shortage may have a pronounced impact on aging rural communities. Our objective was to describe the demographic trends and scope of practice of rural urologists using data from the American Urological Association Census.

METHODS: We conducted a retrospective analysis of American Urological Association Census survey data over a 5-year period (2016-2020), including all U.S.-based practicing urologists. Metropolitan (urban) and nonmetropolitan (rural) practice classifications were based on rural-urban commuting area codes for the primary practice location zip code. We conducted descriptive statistics of demographics, practice characteristics and specific rural-focused survey items.

RESULTS: In 2020, rural urologists were older (60.9 years, 95% CI 58.5-63.3 vs 54.6 years, 95% CI 54.0-55.1) and were in practice longer (25.4 years, 95% CI 23.2-27.5 vs 21.2 years, 95% CI 20.8-21.5) than urban counterparts. Since 2016, mean age and years in practice increased for rural urologists but remained stable for urban urologists, suggesting an influx of younger urologists to urban areas. Compared with urban urologists, rural urologists had significantly less fellowship training and more frequently worked in solo practice, multispecialty groups and private hospitals.

CONCLUSIONS: The urological workforce shortage will particularly impact rural communities and their access to urological care. We hope our findings will inform and empower policymakers to develop targeted interventions to expand the rural urologist workforce.

PMID:37145722 | DOI:10.1097/UPJ.0000000000000311

Urol Pract. 2022 Sep;9(5):491-497. doi: 10.1097/UPJ.0000000000000334. Epub 2022 Jul 5.

ABSTRACT

INTRODUCTION: Burnout has been recognized as an occupational hazard among health care professionals. The objective of this study was to assess the extent and pattern of burnout in advanced practice providers (APPs) in urology by analyzing American Urological Association Census data.

METHODS: The American Urological Association conducts an annual census survey to all providers in the urological care community, including APPs. In the 2019 Census, the Maslach Burnout Inventory questionnaire was included to measure burnout among APPs. Demographic and practice variables were assessed to establish correlating factors to burnout.

RESULTS: A total of 199 APPs (83 physician assistants and 116 nurse practitioners) completed the 2019 Census. Slightly more than 1 in 4 APPs experienced professional burnout (25.3% in physician assistants and 26.7% in nurse practitioners). Observed higher burnout rates were seen in APPs who were aged 45 to 54 (34.3%), women (29.6% vs 10.8% in men, p value <0.05), non-White (33.3% vs 24.9% in White), those who had 4-9 years of practice (32.4%) and those who practiced in academic medical centers (31.7%). Except for gender, none of the above observed differences were statistically significant. Using a multivariate logistic regression model, gender remained the only significant factor associated with burnout (women vs men with an odds ratio of 3.2 [95% confidence interval: 1.1-9.6]).

CONCLUSIONS: Overall, APPs in urological care reported lower levels of burnout than urologists; however, there was a higher chance of female APPs experiencing higher professional burnout in comparison to their male counterparts. Future studies are needed to investigate possible reasons for this finding.

PMID:37145720 | DOI:10.1097/UPJ.0000000000000334

Urol Pract. 2022 Mar;9(2):119-125. doi: 10.1097/UPJ.0000000000000285. Epub 2022 Jan 24.

ABSTRACT

INTRODUCTION: The shift from fee-for-service to value-based payment introduces a new set of challenges and opportunities for the practicing physician. It is unknown how urologists have been impacted by the recent implementation of the merit-based incentive payment system (MIPS). We describe the MIPS performance scores of urologists and investigate their association with practice patterns.

METHODS: Urologists were identified in the 2018 MIPS performance score database and classified by participation status: individual practice, group practice or alternative payment model (APM). The overall MIPS score is comprised of 4 categories: quality, promoting interoperability, cost and improvement activities. Comparative statistics were performed using Tukey’s honest significance test and chi-square analysis. Multinomial logistic regression was performed to test associations.

RESULTS: A total of 9,055 urologists were included with the following average scores: quality 82.5, promoting interoperability 88.9, cost 74.4, improvement activities 37.3 and overall 86.9. When stratified by participation status, urologists in group practices scored higher than individual urologists in each category except cost; urologists in APMs often scored even higher. Preference for group practice or APMs was more common among urologists who graduated medical school more recently. Geographic location also appears to be a contributing factor when evaluating practice type.

CONCLUSIONS: Urologists who participated as a group practice or APM scored higher across most MIPS categories than those in an individual practice. Introduction of a new reimbursement schedule will likely result in further evolution of practice patterns in the future.

PMID:37145697 | DOI:10.1097/UPJ.0000000000000285

JAMA Health Forum. 2023 May 5;4(5):e230673. doi: 10.1001/jamahealthforum.2023.0673.

ABSTRACT

IMPORTANCE: Prior research has reported undertreatment among patients with cancer who are insured by Medicaid, but this finding may be due, in part, to incomplete data in cancer registries.

OBJECTIVE: To compare disparities in radiation and hormone therapy between women with breast cancer covered by Medicaid and those with private insurance using the Colorado Central Cancer Registry (CCCR) and CCCR data supplemented with All Payer Claims Data (APCD).

DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included women aged 21 to 63 years who received breast cancer surgery. We linked the CCCR and Colorado APCD to identify Medicaid and privately insured women who were newly diagnosed with invasive, nonmetastatic breast cancer between January 1, 2012, and December 31, 2017. In the radiation treatment analysis, we narrowed the sample to women who received breast-conserving surgery (Medicaid, n = 1408; private, n = 1984) and in the hormone therapy analysis, we selected women who were hormone-receptor positive (Medicaid, n = 1156; private, n = 1667).

MAIN OUTCOMES AND MEASURES: We used logistic regression to estimate the likelihood of treatment within 12 months to assess whether the results varied between data sources.

RESULTS: There were 3392 and 2823 participants in the radiation and hormone therapy cohorts, respectively. The mean (SD) age was 51.71 (8.30) years in the radiation therapy cohort, and 52.00 (8.16) years in the hormone therapy cohort. Among the participants, there were 140 (4%) and 105 (4%) who were Black non-Hispanic, 499 (15%) and 406 (14%) who were Hispanic, 2602 (77%) and 2190 (78%) were White, and 151 (4%) and 122 (4%) were other/unknown in the radiation and hormone therapy cohorts, respectively. A higher percentage of women were aged 50 years or younger in the Medicaid samples (40% vs 34% in the privately insured sample) and identified as non-Hispanic Black (about 7%) or Hispanic (approximately 24%). Treatment was underreported in both sources, but to a lesser extent in the APCD (2.5% and 2.0% for Medicaid and private insurance, respectively) compared with CCCR (19.5% and 13.3% for Medicaid and private insurance, respectively). Using CCCR data, Women with Medicaid insurance were 4 (95% CI, -8 to -1; P = .02) and 10 (95% CI, -14 to -6; P < .001) percentage points less likely to have a record of radiation and hormone therapy compared with privately insured women, respectively. Using combined CCCR and APCD, no statistically significant disparity was observed in radiation or hormone therapy between Medicaid-insured and privately insured women.

CONCLUSIONS AND RELEVANCE: Among women with breast cancer covered by Medicaid vs private insurance, cancer treatment disparities may be overestimated if based solely on cancer registry data.

PMID:37145688 | DOI:10.1001/jamahealthforum.2023.0673

JAMA Health Forum. 2023 May 5;4(5):e230894. doi: 10.1001/jamahealthforum.2023.0894.

ABSTRACT

IMPORTANCE: Prioritization and funding for health initiatives, including biomedical innovation, may not consistently target unmet public health needs.

OBJECTIVE: To (1) develop a quantitative, databased framework to identify and prioritize opportunities for biomedical product innovation investments based on a multicriteria decision-making model (MCDM) that includes comprehensive measures of public health burden and health care costs, and (2) pilot test the model.

DESIGN, SETTING, AND PARTICIPANTS: The Department of Health and Human Services (HHS) convened public and private experts to develop a model, select measures, and complete a longitudinal pilot study to identify and prioritize opportunities for investment in biomedical product innovations that have the greatest public health benefit. Cross-sectional and longitudinal data (2012-2019) for 13 pilot medical disorders were obtained from the Institute for Health Metrics Global Burden of Disease database (IHME GBD) and the National Center for Health Statistics (NCHS).

MAIN OUTCOME MEASURES: The main outcome measure was an overall gap score reflecting high public health burden (composite measure of mortality, prevalence, years lived with disability, and health disparities), or high health care costs (composite measure of total, public, and out-of-pocket health spending) relative to low biomedical innovation. Sixteen innovation metrics were selected to reflect the pipeline of biomedical products from research and development to market approval. A higher score indicates a greater gap. Normalized composite scores were calculated for public health burden, cost, and innovation investment using the MCDM Technique for Order of Preference by Similarity to Ideal Solution method.

RESULTS: Among the 13 conditions tested in the pilot study, diabetes (0.61), osteoarthritis (0.46), and drug-use disorders (0.39) had the highest overall gap score reflecting high public health burden, or high health care costs relative to low biomedical innovation in these medical disorders. Chronic kidney disease (0.05), chronic obstructive pulmonary disease (0.09), and cirrhosis and other liver diseases (0.10) had the least amount of biomedical product innovation despite similar public health burden and health care cost scores.

CONCLUSIONS: In this cross-sectional pilot study, we developed and implemented a data-driven, proof-of-concept model that can help identify, quantify, and prioritize opportunities for biomedical product innovation. Quantifying the relative alignment between biomedical product innovation, public health burden, and health care cost may help identify and prioritize investments that can have the greatest public health benefit.

PMID:37145687 | DOI:10.1001/jamahealthforum.2023.0894

Urol Pract. 2021 May;8(3):374-379. doi: 10.1097/UPJ.0000000000000212. Epub 2020 Nov 30.

ABSTRACT

INTRODUCTION: We sought to determine the accuracy of self-reported urology applicant match data and determine which factors were most influential on successful application outcomes.

METHODS: A publicly accessible Google spreadsheet entitled “Urology Residency Applicant Spreadsheet” containing self-reported urology residency applicant characteristics and match outcomes was analyzed for differences across the years 2017+2018 (pre-aggregated)-2020. These data were compared to published data from the American Urological Association and the Association of American Medical Colleges. Statistical modeling of the self-reported data was performed to determine which applicant characteristics were predictive of match outcomes.

RESULTS: Averages of self-reported data were similar to published match data with a bias towards more competitive applicants. The factors associated with increased interview offer rate were: Step 1 score, Step 2 score, number of research items, class quartile, and Alpha Omega Alpha membership. Logistic regression modeling correctly predicted an applicant matching to their first-choice program with 74.7% accuracy, with significant negative predictors being the number of programs to which the applicant applied and interviews offered from waitlist or cancellations, and positive predictors being the number of interview offers received.

CONCLUSIONS: Many applicants “apply broadly” with the goal of improving their match outcomes, but we found that applying to more programs is associated with a decreased likelihood of the applicant matching to their first-choice program. Applicant characteristics such as United States Medical Licensing Examination® scores were not related to first-choice match, suggesting that program selection, among other factors, is vital in the match process.

PMID:37145662 | DOI:10.1097/UPJ.0000000000000212

Urol Pract. 2021 May;8(3):355-359. doi: 10.1097/UPJ.0000000000000219. Epub 2021 Feb 8.

ABSTRACT

INTRODUCTION: We evaluated the adherence of urologists within an integrated health care system to Choosing Wisely®, an initiative aimed at avoiding unnecessary medical tests. In urology, 2 of the guidelines state bone scans and pelvic computerized tomography scans are unnecessary in low risk prostate cancer.

METHODS: We performed a retrospective study on patients diagnosed with low risk prostate cancer between January 1, 2010 and December 31, 2017 at Kaiser Permanente Southern California. All demographics and imaging data were obtained. Patients with symptoms concerning for metastatic disease or with other malignancies were excluded by chart review. Statistical analysis was employed to compare the use of bone scans and computerized tomography scans in this population before and after the Choosing Wisely guidelines were published.

RESULTS: Of the 6,996 patients, 121 (1.7%) and 96 (1.4%) underwent a bone scan and computerized tomography scan, respectively. A Cochran-Armitage test showed no change after implementation of the statements. Logistic regression analysis revealed that for every point increase in prostate specific antigen, the odds ratio was 1.09 for ordering both a bone scan and computerized tomography scan. When compared to Whites, the odds ratio of having a bone scan and computerized tomography scan were 0.35 and 0.37 for Blacks, 0.30 and 0.38 for Hispanics, and 0.47 and 0.61 for Asians, respectively.

CONCLUSIONS: Over the study period, there were low rates of inappropriate imaging for low risk prostate cancer. There was no change in trend after publication of the Choosing Wisely. Higher prostate specific antigen levels and White ethnicity were predictors for ordering inappropriate imaging.

PMID:37145659 | DOI:10.1097/UPJ.0000000000000219

Urol Pract. 2021 May;8(3):337-340. doi: 10.1097/UPJ.0000000000000218. Epub 2021 Feb 4.

ABSTRACT

INTRODUCTION: Vasectomy is the most effective form of permanent male contraception. Although vasectomy techniques and outcomes have steadily improved, postvasectomy semen analysis compliance remains a significant challenge. The aim of this study was to assess if home testing improved postvasectomy semen analysis compliance.

METHODS: Data were collected prospectively but retrospectively reviewed between 2007 and 2019 from a single surgeon’s high volume practice. Subjects were divided into 2 groups based on postvasectomy semen analysis method (home vs office) and further subdivided by compliance status. Patients were considered compliant if they provided at least 1 semen sample postvasectomy. Statistical analysis was completed to determine factors predictive of compliance.

RESULTS: A total of 364 patients were included. Median age for the home group vs the office group was similar (42 years [IQR 39-46] vs 41 years [IQR 38-46]). Median number of children for both groups was 2 (IQR 2-3). In all, 109 men (30.0%) opted for at-home testing. No significant difference in compliance was found (59.6% of home test vs 58.8% of laboratory patients, p=0.89). No statistically significant difference in patient demographics (age, partner age, number of children, smoking and alcohol) was observed, and there were no demographic factors predicting compliance with regression modeling.

CONCLUSIONS: At-home semen analysis kits did not significantly improve compliance. Clinicians should be aware that this may be a reasonable alternative for those who are unable to obtain a postvasectomy semen analysis in-office. Contact of the female partner instead may improve postvasectomy semen analysis compliance as the female partner has a stake in ensuring postvasectomy semen analysis azoospermia.

PMID:37145658 | DOI:10.1097/UPJ.0000000000000218