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JU INSIGHT Improving Upper Urinary Tract Stone Surgery Quality: Validation of Efforts to Reduce Emergency Department Visits
By: Andrew M. Higgins, MD, MS, Michigan Urological Surgery Improvement Collaborative (MUSIC), University of Michigan, Ann Arbor; Stephanie Daignault-Newton, MS, Michigan Urological Surgery Improvement Collaborative (MUSIC), University of Michigan, Ann Arbor; Russell E. N. Becker, MD, PhD, Michigan Urological Surgery Improvement Collaborative (MUSIC), University of Michigan, Ann Arbor; Golena Fernandez Moncaleano, MD, Michigan Urological Surgery Improvement Collaborative (MUSIC), University of Michigan, Ann Arbor; Bonnie Cheng, MPH, Michigan Value Collaborative (MVC), University of Michigan, Ann Arbor; Chelsea Abshire Pizzo, MPH, Michigan Value Collaborative (MVC), University of Michigan, Ann Arbor; Michael P. Thompson, PhD, Michigan Value Collaborative (MVC), University of Michigan, Ann Arbor; Bronson Conrado, MHSA, Michigan Urological Surgery Improvement Collaborative (MUSIC), University of Michigan, Ann Arbor; Anna M. Johnson, MS, Michigan Urological Surgery Improvement Collaborative (MUSIC), University of Michigan, Ann Arbor; John M. Hollingsworth, MD, MS, NorthShore University Health System, Evanston, Illinois; Khurshid R. Ghani, MBChB, MS, FRCS, Michigan Urological Surgery Improvement Collaborative (MUSIC), University of Michigan, Ann Arbor; Casey A. Dauw, MD, Michigan Urological Surgery Improvement Collaborative (MUSIC), University of Michigan, Ann Arbor | Posted on: 20 Jul 2023
Higgins AM, Daignault-Newton S, Becker REN, et al. Improving the quality of upper urinary tract stone surgery: external validation of a statewide collaborative’s efforts to reduce emergency department visits after ureteroscopy. J Urol. 2023;210(1):128-135.
Study Need and Importance
The Reducing Operative Complications from Kidney Stones (ROCKS) program in the Michigan Urological Surgery Improvement Collaborative (MUSIC) was created to optimize ureteroscopy outcomes. Through data collection, distribution of reports, patient education, and standardization of medication, postureteroscopy emergency department (ED) visits in Michigan have declined. It is unclear if these declines were the result of MUSIC ROCKS initiatives or were due to national trends. We therefore sought to understand ED visit rates in Michigan compared to a national data set.
What We Found
From 2016 to 2021, the rate of postureteroscopy ED visits declined significantly in the MUSIC ROCKS registry (from 10.5% in 2016 to 6.9% in 2021) compared to a cohort in a large national data set, Clinformatics Data Mart (from 9.6% in 2016 to 10.0% in 2021). A visual representation of this decline can be seen in the Figure. The ED visit rate decline in MUSIC ROCKS outpaced national rates and provides evidence that systematic quality initiatives can improve urological care.
Limitations
Inherent differences in data collection and reporting techniques between a prospective registry (MUSIC ROCKS) and a retrospective claims database could have biased our results. However, by using the same methods within a Michigan-specific claims database we were able to limit the effect of these differences. There were also statistical differences in patient demographics between the cohorts, and despite adjustment in our model, the risk of confounding still exists.
Interpretation for Patient Care
The data presented within this manuscript provide the first external validation of the success of MUSIC ROCKS quality improvement efforts against an external source. This demonstrates that large, statewide quality improvement collaboratives have the ability to effect significant change in improving postoperative outcomes after kidney stone surgery.
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