Predictors and Cost Comparison of Subsequent Urinary Stone Care at Index Versus Non-Index Hospitals

Objective To examine the effects of care fragmentation, or the engagement of different health care systems along the continuum of care, on patients with urinary stone disease. Methods All-payer data from the 2016 Healthcare Cost and Utilization Project (HCUP) State Databases from Florida (FL) and New York (NY) were used to identify a cohort of adult patients with an emergency department visit for a diagnosis of urolithiasis, who subsequently re-presented to an index or non-index hospital for renal colic and/or urological intervention. Patient demographics, regional data, and procedural information were collected and 30-day episode-based costs were calculated. Multivariable logistic and gamma generalized linear regression were utilized to identify predictors of receiving subsequent care at an index hospital and associated costs, respectively. Results Of the 33,863 patients who experienced a subsequent encounter related to nephrolithiasis, 9593 (28.3%) received care at a non-index hospital. Receiving subsequent care at the index hospital was associated with fewer acute care encounters prior to surgery (2.5 vs 2.7; P <.001) and less days to surgery (29 vs 42; P < .001). Total episode-based costs were higher in the non-index setting, with a mean difference of $783 (Non-index: $13,672, 95% CI $13,292-$14,053; Index: $12,889, 95% CI $12,677 - $13,102; P < .001). Conclusion Re-presentation to a unique healthcare facility following an initial diagnosis of urolithiasis is associated with a greater number of episode-related health encounters, longer time to definitive surgery, and increased costs.