Followup Care after Emergency Department Visits for Kidney Stones: A Missed Opportunity

Abstract

Introduction: Followup care after an emergency department visit for kidney stones may help reduce emergency department revisits and increase use of stone prevention strategies. To test these hypotheses we analyzed medical claims from working age adults with kidney stones. Methods: Using data from MarketScan® (2003 to 2006) we identified patients with an emergency department visit for kidney stones. We then determined which patients had an outpatient visit within 90 days of emergency department discharge. Finally, we used multivariable logistic regression to evaluate the association between receipt of followup care and emergency department revisit as well as use of stone prevention strategies (24-hour urine testing and preventive pharmacological therapy prescription). Results: Only 48.0% (33,741) of patients seen in the emergency department for kidney stones received followup care, of which 68.3% was with a urologist. While followup care was not associated with fewer emergency department revisits, patients who received it were more likely to undergo 24-hour urine testing (predicted probability 2.2% vs 0.9%, p <0.001) and be prescribed preventive pharmacological therapy (predicted probability 10.6% vs 8.9%, p <0.001) compared to those who did not receive care. Among patients who received followup care, use of stone prevention strategies was higher when the care was delivered by a urologist (predicted probability 13.7% vs 12.3%, p=0.001). Conclusions: More than half of patients seen acutely in the emergency department for kidney stones do not receive followup care. Given that followup care is associated with greater use of stone prevention strategies, efforts to enhance linkages across health care settings are needed to provide higher quality care for patients with urinary stone disease.