Mp72-01 Do Social Determinants of Health Affect Adherence to the American Urologic Association Cryptorchidism Guideline? A Multi-Institutional Evaluation

You have accessJournal of UrologyPediatrics VII (MP72)1 May 2024MP72-01 DO SOCIAL DETERMINANTS OF HEALTH AFFECT ADHERENCE TO THE AMERICAN UROLOGIC ASSOCIATION CRYPTORCHIDISM GUIDELINE? A MULTI-INSTITUTIONAL EVALUATION Julie R. Solomon, Piroz Bahar, Andrew Bisenius, Miles Duncan, Alethea G. Paradis, Joel Vetter, Jacob D. Hansen, Linder Wendt, Patrick Ten Eyck, Kate H. Kraft, Erica Traxel, Jonathan S. Ellison, and Douglas W. Storm Julie R. SolomonJulie R. Solomon , Piroz BaharPiroz Bahar , Andrew BiseniusAndrew Bisenius , Miles DuncanMiles Duncan , Alethea G. ParadisAlethea G. Paradis , Joel VetterJoel Vetter , Jacob D. HansenJacob D. Hansen , Linder WendtLinder Wendt , Patrick Ten EyckPatrick Ten Eyck , Kate H. KraftKate H. Kraft , Erica TraxelErica Traxel , Jonathan S. EllisonJonathan S. Ellison , and Douglas W. StormDouglas W. Storm View All Author Informationhttps://doi.org/10.1097/01.JU.0001009572.60675.69.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous research indicates that the 2014 American Urologic Association (AUA) Cryptorchidism Guideline has not impacted quality of care indicator such as the use of sonography prior to urologic evaluation or timing of referral by general practitioners. Our multi-institutional collaborative evaluated whether local indicators of healthcare access are associated with these quality-of-care indicators. METHODS: Boys referred for cryptorchidism to our institutions prior to guideline creation (2013) and following guideline creation (2015 and 2019) were retrospectively analyzed. Local indicators of healthcare access, such as median county income, distance to tertiary center, and insurance status, were assessed through geocoding based on patient zip codes cross-referenced to the Rural Health Information and Health Resources and Service Administration websites. Using univariate generalized linear mixed models, we evaluated the association of geocoded factors to the likelihood of pre-evaluation sonography and mean age at referral. We evaluated these trends over time using generalized linear mixed modeling. RESULTS: A total of 3,243 patients were evaluated. The predictive values of each local indicator on the likelihood of receiving a pre-evaluation ultrasound and a timely referral are shown in Table 1. Boys from rural and designated health shortage areas were more likely to undergo sonography 1.38 (1.06, 1.81), 20.5 (4.83, 87.2) and more likely to be referred to a surgeon at a younger age (0.87 (0.78,0.97), 0.70 (0.53, 0.93). Conversely, boys with private insurance, those residing near a referral center, and those from wealthier counties were less likely to undergo sonography 0.48 (0.27, 0.86), 0.53 (0.42, 0.66), 0.42 (0.30, 0.59). There was minimal change in the quality-of-care indicators over time. CONCLUSIONS: Boys with cryptorchidism living in rural, poorer, and medically underserved areas were more likely to receive a pre-evaluation ultrasound yet were more likely to be referred to a pediatric surgeon at a younger age than their counterparts. These data suggest that differing drivers of quality of care may exist pertaining to timing of referral and resource utilization. AUA guideline adherence does not seem to be impacted by these factors. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1171 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Julie R. Solomon More articles by this author Piroz Bahar More articles by this author Andrew Bisenius More articles by this author Miles Duncan More articles by this author Alethea G. Paradis More articles by this author Joel Vetter More articles by this author Jacob D. Hansen More articles by this author Linder Wendt More articles by this author Patrick Ten Eyck More articles by this author Kate H. Kraft More articles by this author Erica Traxel More articles by this author Jonathan S. Ellison More articles by this author Douglas W. Storm More articles by this author Expand All Advertisement PDF downloadLoading ...