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.

Management of women referred to an acute gynecology unit: impact of an ultrasound-based model of care.

OBJECTIVE: To assess the impact of the introduction of an ultrasound-based model of care for women with acute gynecological complications. METHODS: This was a prospective comparative study of women attending an ultrasound-based acute gynecology unit (AGU) at the Nepean Hospital during a 6-week period 4 months after the unit's inception (new model of care), and a group of women presenting at the hospital during a similar period 6 months immediately prior to the unit's inception (traditional model). In the new model of care, ultrasound was performed at the time of the initial assessment by a senior clinician. The main outcome measures were admission rates and occupied bed days. RESULTS: The study included 290 consecutive women with complete data, 133 before and 157 after the introduction of the AGU. Compared with the group presenting before establishment of the AGU, the group who attended the AGU had significantly lower admission rate (7% vs. 36%, P < 0.0001) and significantly shorter time to see a trainee gynecologist (mean, 172 vs. 205 min, P = 0.00089), time to ultrasound examination (mean, 199 vs. 533 min, P < 0.0001), length of stay as an outpatient (mean, 45 vs. 248 min, P < 0.0001), fewer occupied bed days (total, 30 vs. 85 days, P < 0.0001) and lower surgical intervention rates (12% vs. 29%, P = 0.00025). They also had significantly higher expectant management rate (26 vs. 8%, P = 0.00023). The extrapolated annual reduction in occupied bed days represented a total financial saving of $ 257 617 Australian dollars. CONCLUSIONS: In the AGU, the availability of ultrasound carried out by a senior clinician with an interest in gynecological emergencies may lead to a reduction in admissions and improved outcomes.

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.

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.

Avoidable hospitalisations: potential for primary and public health initiatives in Canterbury, New Zealand.

AIM: To investigate the extent of potentially "avoidable hospitalisations" in the Canterbury District Health Board area; specifically, to identify the leading causes, recent trends, and estimated costs of avoidable hospitalisations. METHODS: All hospitalisations in Christchurch Hospital from 2000 to 2004 were analysed and potentially "avoidable admissions" were categorised using ICD10 clinical codes. Costs of these admissions were estimated for the financial year ending 30 June 2003 using diagnostic-related groups (DRGs). RESULTS: The leading causes of potentially "avoidable hospitalisations" in Christchurch Hospital were cardiovascular disease, stroke, respiratory, gastrointestinal, and urinary disorders. The total estimated costs of avoidable hospitalisations in 2003 were NZ 96.6 million dollars, accounting for an estimated 94,462 bed days. The estimated costs of cardiovascular admissions (excluding stroke) were 50.6 million dollars, with stroke accounting for an additional 6.2 million dollars. CONCLUSION: Potentially "avoidable admissions" to Christchurch Hospital comprised 31% of all hospital admissions. There is considerable opportunity to invest in public and primary health initiatives aimed at early detection and intervention, with the major opportunities being identified as cardiovascular disease, stroke, respiratory, gastrointestinal, and urinary disorders.

Evaluating adolescents in juvenile detention facilities for urogenital chlamydial infection: costs and effectiveness of alternative interventions.

CONTEXT: Adolescents in juvenile detention facilities present a unique opportunity to diagnose and treat sexually transmitted diseases. OBJECTIVE: To evaluate the effectiveness and costs of different strategies for the diagnosis and treatment of chlamydial infection in adolescents in juvenile detention.Design, Setting, and Subjects For a cohort of adolescents in a juvenile detention facility, sex-specific decision models were developed comparing strategies for diagnosing and treating chlamydial infection. These strategies included not screening, treating everyone, and testing (with leukocyte esterase [LE], ligase chain reaction [LCR], or history and symptoms) followed by treatment for those with positive test results. Two different time horizons were considered: immediate and extended. In the immediate time horizon, we performed a cost-effectiveness analysis looking only at the outcomes associated with treating current infections; in the extended time horizon, we performed a cost-minimization analysis comparing the estimated total costs of diagnosing and treating Chlamydia as well as those associated with complications occurring up to 20 years in the future. RESULTS: In males, the immediate-time-horizon evaluation revealed that treating on the basis of urine LE results produced the lowest incremental cost-effectiveness ratio ($80 per infection treated). In the extended-time-horizon cost-minimization analysis, treating males on the basis of urine LE results was again found to be the least expensive strategy ($10.11 per person). Two other strategies, confirming urine LE results with LCR ($10.96 per person) and screening with urine LCR ($14.04 per person), were found to be less expensive than not screening ($16.66 per person). In females, the immediate-time-horizon evaluation found that treating on the basis of symptoms and history resulted in treating about half the cases of chlamydial infection and produced the lowest incremental cost-effectiveness ratio ($74 per infection treated). More infections were treated when treatment was based on urine LCR results with only a small increase in the incremental cost per case treated ($95 per infection treated). In the extended-time-horizon cost-minimization analysis, treating all females empirically and treating based on results of urine LCR testing were the least expensive strategies ($18.81 and $18.98 per person, respectively). The results were sensitive to several variables, including prevalence of chlamydial infection, in both males and females. CONCLUSIONS: For adolescent males in juvenile detention facilities, screening with urine LE minimizes the costs associated with diagnosis, treatment, and sequelae of urogenital chlamydial infection. For adolescent females in juvenile detention, empiric treatment and that based on urine LCR test results are the optimal strategies for managing urogenital chlamydial infection.

[Remarks on the introduction of the German Diagnosis-Related Groups (DRGs) for the specialty of urology]. / Anmerkungen zur Einführung der Deutschen Diagnosis-related Groups (G-DRGs) für das Fach Urologie.

In January 2003 a new system to charge inpatient treatment was established in Germany: the G-DRGs. This system is based on the thought that equal medical service causes equal costs all over Germany. Hospitals offering a broad spectrum of diagnostics and therapies and being unable to select their patients according to economical aspects are put at disadvantage: Despite a perfect documentation the G-DRGs reflect their medical service only in an insufficient way. Tools for an optimized coding must be a coding manual created for the specific needs of urologists and an infrastructure that allows a permanent quality control for all persons involved.

The legal framework covering the practice of genitourinary medicine in the UK: the Venereal Diseases Regulations.

The legal framework governing the practice of genitourinary medicine is traced from 1916 to the present. The first legislation, the Public Health (Venereal Diseases) Regulations of 1916 was comprehensive, and accompanied by guidance on setting up outpatient clinics and their supporting laboratories with practical advice on taking samples to support clinical diagnosis. Confidentiality was emphasized. The regulations led to the development of a nationwide network of clinics providing free care, open at times convenient to the public, and situated in general hospitals in large centres of population. Most of the principles still apply. Subsequent legislation centred on maintaining the confidentiality of all information obtained in relation to persons examined or treated for venereal disease, but allows transfer of details between healthcare providers to facilitate care and contact tracing. While the initial regulations stated that the venereal diseases were syphilis, gonorrhoea and chancroid, the legislation now covers all sexually transmitted diseases.

Management of Chlamydia trachomatis genital tract infection in Genitourinary Medicine clinics in the United Kingdom's North Thames Region 1999.

Assessment of clinical management of Chlamydia trachomatis genital tract infection was made, with particular regard to the UK National Guideline. Questionnaires for self-completion, mailed to lead clinicians in 31 Genitourinary Medicine (GUM) clinics in the North Thames Region between May and June 1999, focused on policies and practice. Audit of actual management of up to 10 most recent cases (5 male and 5 female) attending each clinic within the past 2 years was also undertaken. Twenty-two units (71% response) completed the survey questionnaire and 23 units (74% response) audited a total of 229 cases (males=108, females=118, sex not stated=3). Findings indicate that GUM clinics are managing these infections largely as recommended in the national guideline. Nucleic acid amplification techniques will supersede established diagnostic tests for GUM clinics in North Thames, increasing costs for the service, but also sensitivity of detection.

[First evaluation of a year of ambulatory surgery in urology]. / Premier bilan d'une année de chirurgie ambulatoire en urologie.

Day surgery in urology is in full growth actually. The present report is based on our first 120 patients. Low post-operative complication rate, patients' satisfaction and economical savings are the main factors for the important increase in this type of surgery.