Deepak A. Kapoor

Factors associated with emotional distress in newly diagnosed prostate cancer patients

Early identification and intervention have been recommended for newly diagnosed prostate cancer patients who experience significant emotional distress; however, there is little empirical basis for designing or selecting interventions for these men. We sought to identify factors that are associated with distress in these men as a basis for identifying suitable intervention strategies.

Utilization Trends in Prostate Cancer Therapy

PURPOSE We determined therapeutic trends in the management of adenocarcinoma of the prostate, and in the case of intensity modulated radiation therapy we investigated whether site of service influenced those trends. MATERIALS AND METHODS A variety of CPT codes to treat adenocarcinoma of the prostate were extracted from the Medicare Part B 5% sample for the years 2006 to 2008 inclusive. Data were stratified by year, type of service and, in the case of radiation therapy, site of service. Treatment trends were calculated by indexing the total number of Medicare beneficiaries receiving a service against needle biopsies of the prostate. RESULTS The percentage of Medicare beneficiaries receiving therapy indexed to needle biopsies of the prostate increased from 43.8% in 2006 to 49.0% in 2008. Trends in radiation and surgery were similar with 11.5% and 13% increases in each modality, respectively. Total Medicare beneficiaries receiving intensity modulated radiation therapy and laparoscopic radical prostatectomy increased by 25.4% and 22.1%, respectively, while Medicare beneficiaries treated with open radical prostatectomy and 3-dimensional conformal radiation therapy decreased by 27.9% and 37.6%, respectively. The pattern of use for intensity modulated radiation therapy was similar in physician office and hospital facility settings, increasing from 7.3% to 11.1% and 8.3% to 11.3% of Medicare beneficiaries indexed to needle biopsies of the prostate receiving intensity modulated radiation therapy at these sites in 2008, respectively. CONCLUSIONS Treatment trends in surgery and radiation strongly favor newer technologies, and in the case of intensity modulated radiation therapy, utilization trends for treatment of adenocarcinoma of the prostate are similar across all sites of service.

A Method for the Rapid Detection of Urinary Tract Infections

OBJECTIVE To determine the reliability of a rapid detection method compared with the reference standard streaked agar plate in diagnosing the presence of urinary tract infection (UTI). METHODS De-identified clean catch urine specimens from 980 office visit patients were processed during a 30-day period. Classic 1-μL and 10-μL streaked agar plates were used in parallel with the new CultureStat Rapid UTI Detection System (CSRUDS). Urine results were evaluated using the CSRUDS at 30 and 90 minutes after collection. A comparative analysis of the subsequent plate results versus the CSRUDS results was achieved for 973 of these samples. RESULTS Positive UTI conditions were accurately identified by both CSRUDS and agar streak plate methods. CSRUDS accurately identified UTI negative conditions with 99.3% reliability at 90 minutes. The negative predictive value of CSRUDS was 99.2% at 30 minutes. CONCLUSION Current agar plating for first-round UTI screening has substantial documented problems that can negatively affect an accurate and timely UTI diagnosis. A novel rapid detection system, the CSRUDS provides UTI negative/positive same-day results in ≤ 90 minutes from the start of test. Such rapidly available results will enable more accurate and timely clinical decisions to be made in the urology office, particularly regarding infection status before urologic instrumentation.

Determinants of Patient Satisfaction with Urology Practice

Introduction: Although patient satisfaction surveys will be used by CMS (Centers for Medicare & Medicaid Services) to determine reimbursement in physician offices within 2 years, there are no published data to our knowledge on what influences patient satisfaction with the urology office. Therefore, we evaluated which parameters had the greatest impact on a patients likelihood to refer another patient to our practice. Methods: We employed a national survey firm to mail patient satisfaction questionnaires consisting of 21 questions covering parameters on logistics, practice and physician interactions to a random subset of urology outpatients. Data on number of patients seen, wait time in clinic, survey response rate and likelihood to refer were also collected. Interrelations between survey parameters were analyzed using a Pearson product‐moment correlation and Fishers transformation. Results: During a 2‐year period we received 58,932 responses to 211,679 surveys (27.8% response rate). Although logistical and staff parameters correlated positively with likelihood to refer, the strongest correlation was observed in physician parameters (r=0.947, p <0.01). Of physician parameters, patient confidence in physician correlated most strongly with likelihood to refer (r=0.976, p <0.01). Clinic wait time showed a relatively weak correlation to likelihood to refer (r= 0.500, p <0.01), while number of patients seen did not correlate to likelihood to refer (r=−0.090, p=0.40). Survey response correlated positively with likelihood to refer (r=0.593, p <0.01). Conclusions: Our large series demonstrates that patient satisfaction in the urology office correlates most strongly with patient‐physician interaction. Implementation of systematic, comprehensive patient satisfaction surveys is feasible for urology practices and can provide meaningful data to enhance the patient experience.

Utilization and cancer detection by U.S. prostate biopsies (2005-2011).

107 Background: To assess the positive biopsy rate and core sampling pattern in patients undergoing prostate biopsy in the US at a national reference laboratory and pathology laboratories integrated into urology group practices and analyze the relationship between positive biopsy rates and number of specimen vials per biopsy (sv/b). METHODS For the years 2005-11, we collected pathology data from a national reference laboratory (NRL) including number of urologists and urology practices referring samples, total specimen vials submitted per prostate biopsy, and final diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia or atypical small acinar proliferation. Over the same period, similar data was gathered from urology practices with in-house laboratories performing global pathology services (urology practice labs, UPL) identified by a member survey of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials/biopsy were calculated in aggregate and separately for each site of service. RESULTS From 2005-11, 437,937 biopsies were submitted in 4,230,129 vials (9.4 sv/b); overall positive biopsy rate was 40.3%, identical at both the NRL and UPL (p=0.97). Nationally, the number of specimen vials/biopsy increased sharply from a mean of 8.8 during 2005-8 to 10.3 from 2009-11 (difference 1.5 sv/b, p=0.03). For the most recent 3 year period (2009-11), there was no significant difference between the NRL (10.0 sv/b) and UPL (10.6 sv/b) (p=0.08). Positive biopsy rate correlated strongly (p<0.01) with number of specimen vials/biopsy. CONCLUSIONS The positive prostate biopsy rate of 40.3% is identical across sites of service. Although there was a national trend towards increased specimen vials/biopsy from 2005-11, from 2009-11 there was no significant difference in specimen vials/biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10-12 unique specimen vials has been adopted by urologists across sites of service and can be considered the de facto national standard of care.

PNFLBA-06 THE IMPACT OF SCRIBES ON OFFICE PRODUCTIVITY IN UROLOGY PRACTICE

INTRODUCTION AND OBJECTIVES: The advent of electronic health records (EHR) has been determined to be a major cause of physician frustration and burnout. One strategy has been the use of scribes to assist with completion of medical records during office visits. Although data suggests that patients accept the presence of scribes and scribes can improve physician satisfaction, there is conflicting data on whether scribes improve productivity and no studies on the impact of scribes specifically in urology. We sought to determine whether the use of scribes improved provider productivity in our urology practice. METHODS: We instituted a voluntary scribe program at our multi-site large urology practice. A total of 20 providers participated in the scribe program (user group, UG). 18 providers practicing in the same physical offices who declined the use of scribes served as a control group (non-user group, NUG). Provider productivity as measured by total evaluation and management (E&M) visits and relative value units (RVUs) visits were aggregated and compared for the 6 months preand post-adoption of the scribe. The month the scribe started was considered a training month and excluded from analysis. Coding patterns were assessed for UG and NUG preand post-scribe as well. Statistical analysis preand post-scribe for each provider was performed using Student’s paired t-test. RESULTS: Pre-scribe E&M visits for UG and NUG were 1613.8 and 1661.1, respectively (difference 47.3, p1⁄40.72). Pre-scribe RVUs for UG and NUG were 11567.7 and 10475.6, respectively (difference 1092.1, p1⁄40.22). For UG post-scribe, significant increases in both E&M visits and total RVUs were observed (E&M visits 1836.9, +13.8%, p1⁄40.00; RVUs 12467.7, +7.8%, p1⁄40.05). Conversely, there was no significant change in either E&M visits or RVUs for NUG (E&M visits 1651.6, -0.6%, p1⁄40.76; RVUs 10576.0, +1.0%, p1⁄40.67). Post-scribe, the difference in RVUs betweenUGandNUGwassignificant (1891.7,p1⁄40.05)while thedifference in RVUs approached, but did not reach, significance (185.3, p1⁄40.08). CONCLUSIONS: To date, there has been no analysis on the impact that the addition of scribes has on productivity in the urology office. Our data suggests that productivity as measured by both office E&M visits as well as total RVUs is significantly improved by the addition of scribes. When combined with other data regarding scribe acceptance by patients and improvements in physician satisfaction, the utilization of scribes is a viable option for urology practices seeking to manage EHR fatigue in their providers.