Ultrasound Evaluation for Children with Cryptorchidism is Expensive and Delays Access to Specialized Care: Single Center Evaluation of Referral Patterns in a Universal Coverage Health Care System
CUA Online Library. Hajiha M. 06/25/13; 31371; MP-09.14
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Abstract
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ULTRASOUND EVALUATION FOR CHILDREN WITH CRYPTORCHIDISM IS EXPENSIVE AND DELAYS ACCESS TO SPECIALIZED CARE: SINGLE CENTER EVALUATION OF REFERRAL PATTERNS IN A UNIVERSAL COVERAGE HEALTH CARE SYSTEM
Niki Kanaroglou, Elias J Wehbi, Mohammed Hajiha, Joao L. Pippi Salle, Darius J. Bagli, Luis H. P. Braga, Cathy Daniels, Walid Farhat, Martin A. Koyle, Armando J. Lorenzo
Existing literature shows that ultrasonography (US) adds little guidance when assessing children with undescended testes (UDT). We hypothesize that US remains overused, delaying definitive treatment and affecting healthcare resource allocation. Herein, we analyze patterns of US use, focusing on costs and ultimate impact on timely surgical care.
Consecutive referrals for UDT from 2007-2009 to a single tertiary care center were evaluated, excluding children with previous inguino-scrotal surgery. Patients were stratified and compared based on US studies obtained before specialist visit. Times between evaluation by referring doctor and specialist (Rf-Sp), evaluation by referring physician and surgery (Rf-Sx), and specialist exam to surgery (Sp-Sx) were compared. Costs were estimated based on contemporary provincial reimbursement fees.
362 patients presented for evaluation (236/362, 65% palpable UDT; 57/362, 16% non palpable, 69/362, 19% normal exam). Of these, 169 (46%) had at least one US prior to specialist visit, totaling ~$28,779CAD. For palpable, non-palpable and normal testes, frequency of US use was comparable (52%, 43% and 45%, p>0.05). Median age at referral was 2.3 years. Most referrals were from family physicians (37%) and pediatricians (42%), with no difference in US ordering preference (p=0.5). Mean Rf-Sp was longer in patients with US before referral (238 vs. 136 days, p<0.0001). Mean Rf-Sx was 347 vs. 213 days in those who did not have US (p<0.0001). There was no difference in mean Sp-Sx for US and non-US groups (74 and 84 days, p=0.5). In 51 boys with US request dates available, mean time from request to referral was 134 days.
Our findings indicate an overall delay in definitive surgical treatment for UDT, significantly magnified when an US is ordered prior to specialist referral. This highlights a modifiable misuse of valuable resources in the current era of cost containment, particularly in a system already burdened with long surgical wait times.
Niki Kanaroglou, Elias J Wehbi, Mohammed Hajiha, Joao L. Pippi Salle, Darius J. Bagli, Luis H. P. Braga, Cathy Daniels, Walid Farhat, Martin A. Koyle, Armando J. Lorenzo
Existing literature shows that ultrasonography (US) adds little guidance when assessing children with undescended testes (UDT). We hypothesize that US remains overused, delaying definitive treatment and affecting healthcare resource allocation. Herein, we analyze patterns of US use, focusing on costs and ultimate impact on timely surgical care.
Consecutive referrals for UDT from 2007-2009 to a single tertiary care center were evaluated, excluding children with previous inguino-scrotal surgery. Patients were stratified and compared based on US studies obtained before specialist visit. Times between evaluation by referring doctor and specialist (Rf-Sp), evaluation by referring physician and surgery (Rf-Sx), and specialist exam to surgery (Sp-Sx) were compared. Costs were estimated based on contemporary provincial reimbursement fees.
362 patients presented for evaluation (236/362, 65% palpable UDT; 57/362, 16% non palpable, 69/362, 19% normal exam). Of these, 169 (46%) had at least one US prior to specialist visit, totaling ~$28,779CAD. For palpable, non-palpable and normal testes, frequency of US use was comparable (52%, 43% and 45%, p>0.05). Median age at referral was 2.3 years. Most referrals were from family physicians (37%) and pediatricians (42%), with no difference in US ordering preference (p=0.5). Mean Rf-Sp was longer in patients with US before referral (238 vs. 136 days, p<0.0001). Mean Rf-Sx was 347 vs. 213 days in those who did not have US (p<0.0001). There was no difference in mean Sp-Sx for US and non-US groups (74 and 84 days, p=0.5). In 51 boys with US request dates available, mean time from request to referral was 134 days.
Our findings indicate an overall delay in definitive surgical treatment for UDT, significantly magnified when an US is ordered prior to specialist referral. This highlights a modifiable misuse of valuable resources in the current era of cost containment, particularly in a system already burdened with long surgical wait times.
ULTRASOUND EVALUATION FOR CHILDREN WITH CRYPTORCHIDISM IS EXPENSIVE AND DELAYS ACCESS TO SPECIALIZED CARE: SINGLE CENTER EVALUATION OF REFERRAL PATTERNS IN A UNIVERSAL COVERAGE HEALTH CARE SYSTEM
Niki Kanaroglou, Elias J Wehbi, Mohammed Hajiha, Joao L. Pippi Salle, Darius J. Bagli, Luis H. P. Braga, Cathy Daniels, Walid Farhat, Martin A. Koyle, Armando J. Lorenzo
Existing literature shows that ultrasonography (US) adds little guidance when assessing children with undescended testes (UDT). We hypothesize that US remains overused, delaying definitive treatment and affecting healthcare resource allocation. Herein, we analyze patterns of US use, focusing on costs and ultimate impact on timely surgical care.
Consecutive referrals for UDT from 2007-2009 to a single tertiary care center were evaluated, excluding children with previous inguino-scrotal surgery. Patients were stratified and compared based on US studies obtained before specialist visit. Times between evaluation by referring doctor and specialist (Rf-Sp), evaluation by referring physician and surgery (Rf-Sx), and specialist exam to surgery (Sp-Sx) were compared. Costs were estimated based on contemporary provincial reimbursement fees.
362 patients presented for evaluation (236/362, 65% palpable UDT; 57/362, 16% non palpable, 69/362, 19% normal exam). Of these, 169 (46%) had at least one US prior to specialist visit, totaling ~$28,779CAD. For palpable, non-palpable and normal testes, frequency of US use was comparable (52%, 43% and 45%, p>0.05). Median age at referral was 2.3 years. Most referrals were from family physicians (37%) and pediatricians (42%), with no difference in US ordering preference (p=0.5). Mean Rf-Sp was longer in patients with US before referral (238 vs. 136 days, p<0.0001). Mean Rf-Sx was 347 vs. 213 days in those who did not have US (p<0.0001). There was no difference in mean Sp-Sx for US and non-US groups (74 and 84 days, p=0.5). In 51 boys with US request dates available, mean time from request to referral was 134 days.
Our findings indicate an overall delay in definitive surgical treatment for UDT, significantly magnified when an US is ordered prior to specialist referral. This highlights a modifiable misuse of valuable resources in the current era of cost containment, particularly in a system already burdened with long surgical wait times.
Niki Kanaroglou, Elias J Wehbi, Mohammed Hajiha, Joao L. Pippi Salle, Darius J. Bagli, Luis H. P. Braga, Cathy Daniels, Walid Farhat, Martin A. Koyle, Armando J. Lorenzo
Existing literature shows that ultrasonography (US) adds little guidance when assessing children with undescended testes (UDT). We hypothesize that US remains overused, delaying definitive treatment and affecting healthcare resource allocation. Herein, we analyze patterns of US use, focusing on costs and ultimate impact on timely surgical care.
Consecutive referrals for UDT from 2007-2009 to a single tertiary care center were evaluated, excluding children with previous inguino-scrotal surgery. Patients were stratified and compared based on US studies obtained before specialist visit. Times between evaluation by referring doctor and specialist (Rf-Sp), evaluation by referring physician and surgery (Rf-Sx), and specialist exam to surgery (Sp-Sx) were compared. Costs were estimated based on contemporary provincial reimbursement fees.
362 patients presented for evaluation (236/362, 65% palpable UDT; 57/362, 16% non palpable, 69/362, 19% normal exam). Of these, 169 (46%) had at least one US prior to specialist visit, totaling ~$28,779CAD. For palpable, non-palpable and normal testes, frequency of US use was comparable (52%, 43% and 45%, p>0.05). Median age at referral was 2.3 years. Most referrals were from family physicians (37%) and pediatricians (42%), with no difference in US ordering preference (p=0.5). Mean Rf-Sp was longer in patients with US before referral (238 vs. 136 days, p<0.0001). Mean Rf-Sx was 347 vs. 213 days in those who did not have US (p<0.0001). There was no difference in mean Sp-Sx for US and non-US groups (74 and 84 days, p=0.5). In 51 boys with US request dates available, mean time from request to referral was 134 days.
Our findings indicate an overall delay in definitive surgical treatment for UDT, significantly magnified when an US is ordered prior to specialist referral. This highlights a modifiable misuse of valuable resources in the current era of cost containment, particularly in a system already burdened with long surgical wait times.
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