Home > Publications . Search All . Browse All . Country . Browse PSC Pubs . PSC Report Series

PSC In The News

RSS Feed icon

Murphy says mobile sensor data will allow adaptive interventions for maximizing healthy outcomes

Frey comments on why sunbelt metro area economies are still struggling

Krause says having religious friends leads to gratitude, which is associated with better health

Highlights

PSC Fall 2014 Newsletter now available

Martha Bailey and Nicolas Duquette win Cole Prize for article on War on Poverty

Michigan's graduate sociology program tied for 4th with Stanford in USN&WR rankings

Jeff Morenoff makes Reuters' Highly Cited Researchers list for 2014

Next Brown Bag

Monday, Oct 20
No brown bag this week

Medical Expulsive Therapy versus Early Endoscopic Stone Removal for Acute Renal Colic: An Instrumental Variable Analysis

Publication Abstract

Hollingsworth, John M., Edward Norton, Samuel R. Kaufman, R. Matthew Smith, J. Stuart Wolf, and Brent K. Hollenbeck. 2013. "Medical Expulsive Therapy versus Early Endoscopic Stone Removal for Acute Renal Colic: An Instrumental Variable Analysis." Journal of Urology, 190(3): 882-887.

Purpose: The use of medical expulsive therapy to hasten stone passage potentially decreases expenditures around episodes of renal colic. However, these efficiency gains may be mitigated if patients treated with medical expulsive therapy have frequent health care encounters due to pain while waiting for the stones to pass. Materials and Methods: Using claims data (2002 to 2006) we identified adult men with acute renal colic. We compared 6-week payments as well as frequency of hospitalization and emergency department revisits associated with an initial course of medical expulsive therapy with those for early endoscopic stone removal. To account for unmeasured confounding we performed an instrumental variable analysis, exploiting variation in recommended treatments based on the day of the week that a patient's first emergency department visit occurred. Results: Overall 1,835 and 4,397 men underwent medical expulsive therapy or early endoscopic stone removal, respectively. Although minimal differences existed between men with respect to the day of the week of emergency department presentation, weekend encounters were strongly associated with receiving medical expulsive therapy (p <0.001). Two-stage least squares regression revealed 6-week payments to be tenfold lower for men on medical expulsive therapy who were candidates for either treatment (p <0.001). While there was no difference in frequency of hospitalization, these men were more likely to have a repeat emergency department visit compared to those who underwent endoscopic stone removal (68.8% vs 39.6%, respectively, p = 0.025). Conclusions: Findings on medical expulsive therapy are mixed, with lower 6-week payments but more frequent repeat emergency department visits. These data inform patients who are candidates for medical expulsive therapy or endoscopic stone removal when making decisions about their care.

DOI:10.1016/j.juro.2013.03.040 (Full Text)

Browse | Search : All Pubs | Next