Background: Like most urology practices, Skyline Urology in California had the challenge of juggling scheduled patients with several unscheduled patients with acute urinary tract infection (UTI) symptoms. Patients who could not be seen the same day would be guided to the nearest urgent care or emergency department (ED). With ED costs in 2017 totaling $76.3 billion, and the average ED visit costing $690 for patients 65 years and older,1,2 UTIs are the most common type of bacterial infection. Over 1 million ED visits every year in the United States are related to UTIs.3 The focus was to decrease the number of ED visits related to UTIs by utilizing patient navigation to safely triage and coordinate care for a UTI clinic. Skyline Urology also fulfilled Chronic Care Management (CCM) requirements4 to provide comprehensive care to UTI clinic patients and to get reimbursed for that care.
Objectives: To improve patient access and reduce ED visits with technology-guided UTI clinic coordination: thorough history taking for UTI symptoms, coordination of urine tests orders, and timely follow-up of both patients and results to improve patient access and reduce ED visits. Secondary objective was to support the UTI clinic via CCM reimbursements.
Methods: Using a workflow specific to cystitis, patient navigators were prompted to walk through a series of questions when patients would call with acute UTI symptoms and could not be seen the same day. Navigators would then execute on standing orders and coordinate urine test collection, drop-off, and follow-up. Providers would receive comprehensive history of patient symptoms, including a same-day urinalysis, and make medical decisions for same-day care. Quantitative research methods were used to collect urine tests ordered, ED visits averted, and CCM reimbursement received. Patient navigators select tasks completed, including urinalysis, urine culture, and urine PCR (polymerase chain reaction)/NGS (next-generation sequencing) tests. In addition, navigators would select patient outcomes in the patient navigation software, including ED visit aversion. The primary outcome measure was the number of ED visits averted. A limitation of the method is reliance on patient navigator documentation on patient outcomes and urine tests ordered.
Results: In the first 12 months, 125 patients with cystitis participated in the program. The responses were used to inform physician decisions around the types of labs to order and the prescriptions needed. As a result, 88% of these patients were able to avoid an ED visit. One hundred eighteen urinalyses, 115 urine cultures, and 88 urine PCR/NGS tests were ordered. Further, Skyline Urology generated $69,000 in CCM reimbursement for holistic coordination of care for patients with cystitis with the use of a .25 full-time employee.
Conclusion: As a result, Skyline has improved access for patients with UTIs to their providers while reducing ED visits. The UTI clinic coordinated by patient navigators and managed by urologists averted ED visits for 110 patients in 1 year. Success of this program is one example of how patient navigators can assist in reducing UTI-related ED visits while optimizing patient safety.
- Moore BJ, Liang L. Costs of Emergency Department Visits in the United States, 2017. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project. Statistical Brief #268. https://hcup-us.ahrq.gov/reports/statbriefs/sb268-ED-Costs-2017.pdf.
- Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49:53-70.
- Litwin MS, Saigal CS, Yano EM, et al. Urologic diseases in America Project: analytical methods and principal findings. J Urol. 2005;173:933-937.
- Centers for Medicare & Medicaid Services. Medicare Learning Network. Chronic Care Management. www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf.