title: Institutional characteristics associated with receipt of emergency care for obstructive pyelonephritis at community hospitals.
abstract: OBJECTIVE
  Delivering the recommended care is an important quality measure that has been insufficiently studied in urology. Obstructive pyelonephritis is a suitable case study for this focus because many patients do not receive such care, although guidelines advocate decompression. We determined the influence of hospital factors, particularly familiarity with urolithiasis, on the likelihood of decompression in such patients.
  
  
  METHODS
  We used the NIS from 2002 to 2011 to retrospectively identify patients admitted to community hospitals with severe infection and ureteral calculi. Hospital familiarity with nephrolithiasis was estimated by calculating hospital stone volume (divided into quartiles) and hospital treatment intensity (the decompression rate in patients with ureteral calculi and no infection). After calculating national estimates we performed logistic regression to determine the association between the receipt of decompression and hospital stone volume, controlling for treatment intensity and other covariates thought to be associated with receiving recommended care.
  
  
  RESULTS
  Of an estimated 107,848 patients with obstructive pyelonephritis 27.4% failed to undergo decompression. Discrepancies were greatest between hospitals with the highest and lowest stone volumes (76% vs 25%, OR 2.77, 95% CI 1.94-3.96, p <0.01) as well as high and low treatment intensity (78% vs 37%, p <0.01).
  
  
  CONCLUSIONS
  High hospital stone volume and treatment intensity were associated with an increased likelihood of receiving decompression. Such findings might be useful to identify hospitals and regions where access to quality urological care should be augmented.
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, New York.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Borofsky
authors.affiliation: Divisions of Comparative Effectiveness and Decision Science, New York University Langone Medical Center, New York, New York.
authors.forename: Dawn
authors.initials: D
authors.lastname: Walter
authors.affiliation: Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, New York.
authors.forename: Huilin
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, New York; Section of Urology, New York Harbor Veterans Affairs Healthcare System, New York, New York.
authors.forename: Ojas
authors.initials: O
authors.lastname: Shah
authors.affiliation: Nephrology Division, New York University Langone Medical Center, New York, New York; Nephrology Section, New York Harbor Veterans Affairs Healthcare System, New York, New York.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldfarb
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, New York; Section of Urology, New York Harbor Veterans Affairs Healthcare System, New York, New York.
authors.forename: R Ernest
authors.initials: RE
authors.lastname: Sosa
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, New York; Divisions of Comparative Effectiveness and Decision Science, New York University Langone Medical Center, New York, New York; Section of Urology, New York Harbor Veterans Affairs Healthcare System, New York, New York. Electronic address: danil.makarov@nyumc.org.
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
mesh_terms: D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011704:Pyelonephritis / Q000209:etiology / Q000628:therapy*; D014514:Ureteral Calculi / Q000150:complications
keywords: community; hospitals; nephrolithiasis; pyelonephritis; sepsis; ureteral calculi