Association between multiple chronic conditions and urolithiasis.

PURPOSE: Given the risk factors for stone disease, it is possible that multiple chronic condition (MCC) patients are at increased risk of developing new, recurrent, or worsening urolithiasis. The purpose of our investigation was to evaluate the relationship between MCCs and urolithiasis. METHODS: Retrospective cohort using outpatient claims data for all adult members (≥18 years) of the Beaumont Employee Health Plan who received outpatient care between 2008 and 2013. Multiple logistic regression adjusted for age, sex, obesity, hyperlipidemia, hypertension, and diabetes was used to assess the relationship between number of comorbid chronic conditions and urolithiasis. RESULTS: The cohort consisted of 34,173 adult patients with an average age of 40.4 years and 61.2% being female. The prevalence of urolithiasis was 3.1% (n = 1059). Patients with urolithiasis had a significantly higher average number of comorbid chronic conditions (2.4 vs. 1.3, p < 0.001) than patient without urolithiasis. Both crude (OR 1.34; 95% CI 1.30-1.38) and adjusted logistic regression models (OR 1.37; 95% CI 1.31-1.44) revealed a significant relationship between number of comorbid chronic conditions and urolithiasis. More than 81% of patients had one or more co-occurring chronic conditions; the most common MCC combinations associated with urolithiasis were hypertension-hyperlipidemia, chronic back pain, and hyperlipidemia. CONCLUSION: We report an association between MCCs and urolithiasis. Future research is needed to better understand the temporality and strength of this relationship. Physicians should recognize that urolithiasis and MCCs are closely related and therefore may consider more aggressive primary prevention of chronic disease and improved management of MCCs.

Prostate cancer screening practices and diagnoses in patients age 50 and older, Southeastern Michigan, pre/post 2012.

INTRODUCTION: Studies investigating the regional impact of the 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against the use of prostate specific antigen (PSA) screening for prostate cancer have been limited. METHODS: A retrospective cohort study was conducted on men age 50years and older in Southeastern Michigan pre (n=3647) and post (n=3618) USPSTF recommendation. PSA screening, transrectal ultrasound, and prostate biopsy rates were evaluated pre/post using a generalized piecewise linear model with a Poisson distribution, and log link. A knot was placed at year 2011 to estimate pre/post slope coefficients. Generalized estimating equations were used to estimate the marginal probability of a prostate diagnosis as a logistic function of pre and post-period, and comorbidities. RESULTS: PSA utilization significantly increased (ß=0.28; 95% CI: 0.25, 0.31) during the pre-period, but significantly decreased in the post-period (ß=-0.29; 95% CI: -0.34, -0.25). Prostate biopsies decreased pre (ß=-0.16; 95% CI: -0.25, -0.08) and did not change post (ß=0.01; 95% CI: -0.09, 0.12). Transrectal ultrasounds were stable pre (ß=0.16; 95% CI: -0.03, 0.35) and significantly decreased post (ß=-0.27; 95% CI: -0.50, -0.04). Patients in the post-period had a decreased probability of having a diagnosis of prostate cancer (OR: 0.81; 95% CI: 0.74-0.89) compared to the pre-period. CONCLUSION: Our study demonstrates how PSA tests are still being frequently used in Southeastern Michigan. Further research is needed to better understand regional variation in prostate cancer screening practices in the U.S.

Prevalence and Associated Cost and Utilization of Multiple Chronic Conditions in the Outpatient Setting among Adult Members of an Employer-Based Health Plan.

Patients with multiple chronic conditions (MCCs) are a significant concern for the US health care system. MCC patients represent an increasing proportion of the US population and are associated with increased health care cost and utilization, and poor quality of care. Research that has been conducted on MCC patients to date has been at the national level using large data sets, such as Medicare and Medicaid claims and the National Inpatient Sample. These studies have produced research evidence that may be of little utility to individual employer-based health plans given the inherent differences in the patient populations they serve. This study analyzed evaluation and management claims for patients ages 18 years and older (n=632,477) from the Beaumont Employee Health Plan (BEHP), a regional health insurance provider serving Beaumont Health System employees and their families across Southeastern Michigan. The study found that individuals with MCCs are associated with increased cost and visits, and decreased time between appointments in the outpatient setting. Despite decreasing prevalence of MCCs over the study period, substantial increases in cost and visits, and a decrease in time between appointments was observed for MCC patients. Asthma and chronic back pain were uniquely identified as additional primary targets for disease management programs for employer-based health plans. These findings speak to the value of studying MCCs at the employer-based health plan level, where population-specific MCCs can be identified for meaningful intervention and management. Significant opportunity exists for employer-based health plans to study, prevent, and manage MCCs among adult patients.

Multiple chronic conditions among outpatient pediatric patients, southeastern Michigan, 2008-2013.

Studies investigating the prevalence of multiple chronic conditions (MCCs) and their associated health care cost and use among pediatric populations have been limited. Among 14,404 pediatric patients receiving outpatient care in southeastern Michigan from 2008 through 2013, 82.1% had 0 chronic conditions, 16.2% had 1 chronic condition, and 1.6% had 2 or more chronic conditions. Greater numbers of chronic conditions significantly predicted outpatient cost (ß = 581.7, P < .001), visit frequency (ß = 9.1, P < .001), and days between appointments (ß = -33.9, P < .001). Further study of MCCs among pediatric patients is needed given their increasing prevalence and their associated health care cost and use.