Genitourinary Complications Are a Leading and Expensive Cause of Emergency Department and Inpatient Encounters for Persons With Spinal Cord Injury.

OBJECTIVES: To determine the rates of emergency department (ED) visits and inpatient hospitalizations for genitourinary (GU) complications after spinal cord injury (SCI) using a national sample; to examine which patient and facility factors are associated with inhospital mortality; and to estimate direct medical costs of GU complications after SCI. DESIGN: Retrospective cross-sectional and cost analysis of the 2006 to 2015 National Inpatient Sample and National Emergency Department Sample from the Healthcare Cost and Utilization Project. PARTICIPANTS: SCI-related encounters using various International Classification of Disease, Ninth Edition, Clinical Modification diagnosis codes. The inpatient sample included 1,796,624 hospitalizations, and the ED sample included 618,118 treat-and-release visits. MAIN OUTCOME MEASURES: The exposure included a GU complication, identified by International Classification of Disease, Ninth Edition, Clinical Modification codes 590-599. The outcomes then included an ED visit or hospitalization, death prior to discharge, and direct medical costs estimated from reported hospital charges. RESULTS: For the inpatient sample, we observed a 2.5% annual increase (95% confidence interval [CI], 1.8-3.2) in the proportion of SCI-related hospitalizations with any GU complication from 2006 to 2011, and a lesser rate of increase of 0.9% (95% CI, 0.4-1.4) each year from 2011 to 2015. Age, level of injury, and payer source were correlated to inhospital mortality. The costs of GU-related health care use exceeded $4 billion over the study period. CONCLUSIONS: This study shows the rates and economic burden of health care use associated with GU complications in persons with SCI in the United States. The need to develop strategies to effectively deliver health care to the SCI population for these conditions remains great.

Factors of hospitalization expenditure of the genitourinary system diseases in the aged based on "System of Health Account 2011" and neural network model.

BACKGROUND: Hospitalization expenditure of genitourinary system diseases among the aged is often overlooked. The aim of our research is to analyze the basic situation and influencing factors of hospitalization expenditure of the genitourinary system diseases and provide better data for the health system. METHODS: A total of 1 377 681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and "System of Health Account 2011" (SHA2011) was conducted to analyze the expenditure of the diseases. The corresponding samples were extracted, the neural network model was utilized to fit the regression model of the diseases among the aged, and sensitivity analysis was used to rank the influencing factors. RESULTS: Total hospitalization expenditure in Liaoning was 51.286 billion yuan, and curative care expenditure of diseases of the genitourinary system was 3.350 billion yuan, accounting for 6.53%. In the neural network model, the training set of R2 was 0.71. The test set of R2 was 0.74. In the sensitivity analysis, top-three influencing factors were the length of stay, type of institutions and type of insurances; the weight was 0.28, 0.19 and 0.14, respectively. CONCLUSIONS: This research used SHA2011 to grab a large amount of data and analyzed them depending upon the corresponding dimensions. The neural network can analyze the influencing factors of hospitalization expenditure of genitourinary diseases in elderly patients accurately and directly, and can clearly describe the extent of its impact by combining sensitivity analysis.

Hospital burden of long-term genitourinary and gastrointestinal toxicity after radical radiotherapy for prostate cancer.

INTRODUCTION: Treatment options for prostate cancer (PCa) include radical radiotherapy (RT) and radical prostatectomy, both of which have comparable oncological outcomes. The aim of this study was to investigate the hospital burden of long-term genitourinary and gastrointestinal toxicity among patients with PCa who were treated with radiotherapy at our institution. METHODS: The radiotherapy department database was used retrospectively to identify all patients who underwent radiotherapy for PCa from January 2006 to January 2008. The patient administration system from each public hospital in the region was interrogated and all patient points of contact were recorded. Minimum follow up was 5 years. Individual patient charts were reviewed and factors that might influence outcomes were documented. RESULTS: We identified 112 patients. The mean age at diagnosis was 66 (44-76) and the median PSA was 12.1 (3.2-38). The mean duration of follow-up was 7.8 yrs. Twenty-three patients (20%) presented to the Emergency Department (ED) with late onset toxicity. Nine patients had more than 2 ED attendances. Twenty-five patients (22%) were investigated for genitourinary toxicity. Forty-seven patients (42%) underwent investigation for gastrointestinal side-effects and 45% of these required argon therapy (21/47). CONCLUSION: We found a significant hospital burden related to the management of gastrointestinal and genitourinary toxicity post radical radiotherapy for prostate cancer. As health care reforms gain momentum, policy makers must take into account the considerable longitudinal health care cost related to radiotherapy. It is also important that patients are counselled carefully in relation to potential long-term side-effects.

Measuring the quality of performance of a genitourinary medicine primary care team / Medición de la calidad de los resultados de la medicina genitourinaria del equipo de atención primaria

OBJECTIVES: To measure the quality of the clinical Genitourinary (G-U) Medicine and Sexually Transmitted Infection (GUM/STI) management process at a primary care polyclinic and establish a baseline for future monitoring and evaluation. METHODS: This was a prospective cohort study on 220 data abstracted clinical notes randomly selected and stratified by gender, age and first point of contact from 2131 GU/STI patients of the GUM/STI clinic seen from 2003-5. Data were also obtained by tele-interview of a subset of 27 individuals. Measurements were incidence (95% CI) as proportions of successful level of activity and outcome indicators for diagnosis, treatment and prognosis. RESULTS:Among 220 patients, the incidence (95% CI) of accurate clinical diagnosis and treatment was 40.5% (33%, 46%) before laboratory results boosted it to 96% (93%, 99%). Successful prognosis at 1st, 2nd and 3rd follow-up was 23.2%, 56.6% and 86.2%. The risk at follow-up for 1, 2 and >2 GU/STI episodes was 28.9%, 45.8% and 25.3%. Follow-up of partners was low, 4.7%. Adequate health promotion and preventive services were reported in 86.5% (78%, 88%) of 220 patients' records and by 84.5% (71%, 98%) of 26 who were tele-interviewed. In 88.5% (76%, 100%) of those (27) tele-interviewed, there was satisfaction with the service, but 73.8% (56%, 90%) would have preferred appointments and 29.6% (12%, 47%) preferred extended hours. Per capita ideal cost of medication could have been BB$6.30 (± 1.56) instead of actual BB$13.05 (± 1.84); (BB$2 = US$1). CONCLUSION: GU/STI quality performance improvement in Barbados requires rapid laboratory diag-nosis, standardized data formats with prompt expedited partner notification and treatment appointments and use of recommended algorithm that can half the cost of medication. Genitourinary medicine should be strategized instead of STI to better encapsulate the spectrum diversity of presentations and points of service.

OBJETIVO: Medir la calidad de la medicina genitourinaria clínica y el proceso del tratamiento de las infecciones de transmisión sexual (MGU/ITS) en un policlínico de atención primaria, y establecer una línea de base para el monitoreo y la evaluación futuros. MÉTODOS: Se trató de un estudio de cohorte prospectivo realizados sobre 220 notas clínicas extraídas de datos, seleccionadas aleatoriamente y estratificadas por género, edad y primer punto de contacto, de 2131 pacientes MGU/ITS de la clínica MGU/ITS atendidos en 2003-2005, y por tele-entrevista de un subconjunto de 27 individuos. Las mediciones fueron incidencias (95% IC) como proporciones del nivel de éxito de la actividad e indicadores de los resultados para el diagnóstico, el tratamiento y la prognosis. RESULTADOS: Entre 220 pacientes, la incidencia (95% IC) del diagnóstico clínico exacto y el tratamiento fue 40.5% (33%, 46%) antes de que los resultados de laboratorio la elevaran a 96% (93%, 99%). La prognosis exitosa en el primer, segundo y tercer seguimiento fue 23.2%, 56.6% y 86.2%. El riesgo en el seguimiento para los episodios GU/ITS 1, 2, y > 2 fue 28.9%, 45.8% y 25.3%. El seguimiento de parejas fue bajo, 4.7%. La promoción adecuada de la salud y los servicios de prevención fueron reportados en 86.5% (78%, 88%) de las historias de 220 pacientes y por 84.5% (71%, 98%) de 26 que fueron tele-entrevistados. En 88.5% (76%, 100%) de los (27) tele-entrevistados, hubo satisfacción con el servicio, pero 73.8% (56%, 90%) hubiera preferido citas y 29.6% (12%, 47%) extensión del horario. El costo ideal per capita de la medicación podría haber sido 6.30 BBD (± 1.56) en lugar de 13.05 BBD (± 1.84); (2 BBD = 1 USD). CONCLUSIONES: El mejoramiento en cuanto a resultados de calidad en GU/ITS en Barbados, requiere diagnósticos de laboratorio rápidos, formatos estandarizados de datos con pronta notificación a las parejas, citas para el tratamiento, y uso del algoritmo recomendado que puede reducir a la mitad el costo de la medicación. MUG debe ser estrategizada en lugar del TIS, a fin de encapsular mejor el espectro de la diversidad en las presentaciones y puntos de servicio.

Measuring the quality of performance of a genitourinary medicine primary care team.

OBJECTIVES: To measure the quality of the clinical Genitourinary (G-U) Medicine and Sexually Transmitted Infection (GUM/STI) management process at a primary care polyclinic and establish a baseline for future monitoring and evaluation. METHODS: This was a prospective cohort study on 220 data abstracted clinical notes randomly selected and stratified by gender, age and first point of contact from 2131 GU/STI patients of the GUM/STI clinic seen from 2003-5. Data were also obtained by tele-interview of a subset of 27 individuals. Measurements were incidence (95% CI) as proportions of successful level of activity and outcome indicators for diagnosis, treatment and prognosis. RESULTS: Among 220 patients, the incidence (95% CI) of accurate clinical diagnosis and treatment was 40.5% (33%, 46%) before laboratory results boosted it to 96% (93%, 99%). Successful prognosis at 1st, 2nd and 3rd follow-up was 23.2%, 56.6% and 86.2%. The risk at follow-up for 1, 2 and >2 GU/STI episodes was 28.9%, 45.8% and 25.3%. Follow-up of partners was low, 4.7%. Adequate health promotion and preventive services were reported in 86.5% (78%, 88%) of 220 patients' records and by 84.5% (71%, 98%) of 26 who were tele-interviewed. In 88.5% (76%, 100%) of those (27) tele-interviewed, there was satisfaction with the service, but 73.8% (56%, 90%) would have preferred appointments and 29.6% (12%, 47%) preferred extended hours. Per capita ideal cost of medication could have been BB$6.30 (+/- 1.56) instead of actual BB$13.05 (+/- 1.84); (BB$2 = US$1). CONCLUSIONS: GU/STI quality performance improvement in Barbados requires rapid laboratory diagnosis, standardized data formats with prompt expedited partner notification and treatment appointments and use of recommended algorithm that can half the cost of medication. Genitourinary medicine should be strategized instead of STI to better encapsulate the spectrum diversity of presentations and points of service.

The cost-effectiveness of syndromic management for male sexually transmitted disease patients with urethral discharge symptoms and genital ulcer disease in Taiwan.

OBJECTIVE: To assess the cost-effectiveness of syndromic management for the treatment of sexually transmitted diseases (STD) in comparison with the strategies currently used in STD clinics in Taiwan. METHODS: Between July 2004 and June 2005, all male patients with genitourinary symptoms attending two hospitals were included in this study. Current clinical procedures (presumptive treatment and laboratory tests), aetiological diagnosis and syndromic management were compared in terms of diagnostic accuracy, treatment appropriateness, costs and effectiveness. RESULTS: 473 patients met the inclusion criteria and were enrolled in the study. 335 patients (71%) had urethral symptoms (discharge, dysuria or painful urination) and 138 (29%) had genital ulcers, sores and skin rashes. For the current approach, the sensitivity, specificity and positive predictive value (PPV) for the detection of chlamydial, gonococcal and combined forms of infection were 100%, 40.0% and 60.4%, respectively. In contrast, the sensitivity, specificity and PPV for the detection of syphilis were 100%, 86.7% and 70.2%, respectively. For syndromic management, the sensitivity, specificity and PPV detection of chlamydial, gonococcal and combined forms of infection were 85.0%, 40.0% and 56.4%, respectively. In contrast, the sensitivity, specificity and PPV for the detection of syphilis were 78.8%, 18.1% and 23.2%, respectively. The average cost of implementing a correct treatment using the current approach was US$54.27 and US$30.74 for urethritis and syphilis, respectively. For the aetiological approach, the average cost of implementing a correct treatment was US$32.83 and US$21.58 for urethritis and syphilis, respectively. For the syndromic approach, the average cost for a correct treatment was US$3.86 and US$14.30 for urethritis and syphilis, respectively. CONCLUSIONS: In this sample of patients attending STD clinics in Taiwan, syndromic management was found to be a more cost-effective protocol in terms of cost per treated STD patient compared with the current and aetiological protocols for STD.

Hospital costs of older people in New South Wales in the last year of life.

OBJECTIVE: To estimate hospital inpatient costs by age, time to death and cause of death among older people in the last year of life. DESIGN AND SETTING: Cross-sectional analytical study of deaths and hospitalisations in New South Wales from linked population databases. PARTICIPANTS: 70,384 people aged 65 years and over who died in 2002 and 2003. MAIN OUTCOME MEASURES: Hospital costs in the year before death. RESULTS: Care of people aged 65 years and over in their last year of life accounted for 8.9% of all hospital inpatient costs. Hospital costs fell with age, with people aged 95 years or over incurring less than half the average costs per person of those who died aged 65-74 years ($7028 versus $17,927). Average inpatient costs increased greatly in the 6 months before death, from $646 per person in the sixth month to $5545 in the last month before death. Cardiovascular diseases (43.1% of deaths) were associated with an average of $11,069 in inpatient costs, while cancer (25.0% of deaths) accounted for $16,853. The highest average costs in the last year of life were for people who died of genitourinary system diseases ($18,948), and the highest average costs in the last month of life were for people who died of injuries ($8913). CONCLUSION: Population ageing is likely to result in a shift of the economic burden of end-of-life care from the hospital sector to the long-term care sector, with consequences for the supply, organisation and funding of both sectors.