Improving Access and Quality of Care for Kidney Stone Patients in an Underserved Community

Abstract

There is a call to improve Medicaid patient access to healthcare, enhance quality and outcomes of care, and reduce overall financial burden. We sought to build a comprehensive kidney stone program to help patients navigate through the acute and preventative aspects of stone disease by increasing multidisciplinary referrals, compliance to recommendations, no-show rates at first follow-up, and repeat stone encounters after initial evaluation. A collaborative, multi-disciplinary program was established at our single institution consisting of urology, nephrology, and dietary specialists to be piloted over a three-year period. Medicaid-designated patients were evaluated during new patient encounters by urology and then followed for outpatient follow-up including specialty referrals to nephrology and dietitians for targeted preventative measures. Subjective compliance reports by patients following interventions and no-show rates at subsequent follow-ups were documented. We also followed patients 6 months beyond initial encounter to assess for repeat Emergency Department (ED) visits for acute stone episodes. One hundred and eighty-three Medicaid-designated stone patients were evaluated from 2018-2021. Sixty-eight percent of patients identified as white, 18% identified as black/African-American, and 14% identified as “other”. Patients underwent specialty referrals to nephrology or a dietician in 47% and 42% of cases, respectively. Since the program’s implementation, reported patient compliance and referrals to multidisciplinary specialists increased from 72.9% to 81.30% and 21.2% to 56.20%, respectively. Repeat Emergency Department visits for stone related encounters within 6 months of initial presentation remained relatively stable (from 17.60% to 18.9%) while no-show rates at first follow-up decreased from 20.0% to 6.30% by study conclusion. There is continued supporting evidence for the importance of a comprehensive kidney stone program specifically for patients of lower socioeconomic status following a three-year implementation at our institution. Encouraging results indicate increased access to multi-disciplinary specialty referrals, with improvement in follow-up and reported compliance related to stone prevention strategies.