کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3877194 1599022 2006 5 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Regionalization of Percutaneous Nephrolithotomy: Evidence for the Increasing Burden of Care on Tertiary Centers
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیماری‌های کلیوی
پیش نمایش صفحه اول مقاله
Regionalization of Percutaneous Nephrolithotomy: Evidence for the Increasing Burden of Care on Tertiary Centers
چکیده انگلیسی

PurposeThe regionalization of procedures to specialized medical centers has been suggested as a means to improve the quality of care for select high risk procedures. Prior work has demonstrated the spontaneous regionalization of high risk procedures to tertiary centers. Similar concentration of complex, low risk procedures (eg percutaneous nephrolithotomy) to these centers would underscore the increasing burden of care placed on these hospitals.Materials and MethodsWe used the Nationwide Inpatient Sample to identify 12,948 patients who underwent percutaneous nephrolithotomy for stones between 1988 and 2002. Regionalization was measured based on the 6 structural hospital qualities of teaching status, urban location, bed capacity, hospital throughput (all diagnoses), annual percutaneous nephrolithotomy volume and for-profit status. Logistic regression was used to determine the propensity of percutaneous nephrolithotomy to concentrate to these medical centers.ResultsCompared to procedures performed between 1988 and 1990, patients were more likely to undergo percutaneous nephrolithotomy at teaching (OR 1.6, 95% CI 1.3–1.9), high percutaneous nephrolithotomy volume (OR 1.7, 95% CI 1.6–1.9), large bed capacity (OR 1.2, 95% CI 1.1–1.3) and high throughput hospitals (OR 1.4, 95% CI 1.3–1.4) in the years 2000 to 2002.ConclusionsPercutaneous nephrolithotomy, a technically complex but low risk procedure, has spontaneously regionalized to tertiary centers, suggesting the migration of complex surgical care to these centers. The impact of this increasing burden of care on tertiary centers is unclear but may be problematic in the current reimbursement environment.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: The Journal of Urology - Volume 176, Issue 1, July 2006, Pages 242–246
نویسندگان
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