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MP04-06 PERSONALIZED DECISION SUPPORT TOOL TO PREVENT HOSPITAL READMISSION FOR PATIENTS TREATED WITH RADICAL CYSTECTOMY
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THE JOURNAL OF UROLOGYâ
mortality, length of stay (LOS), and total cost after radical cystectomy with IC vs CD were compared. Chi square test and multivariable logistic regression were used to analyze patient and hospital characteristics. Student’s t-test and Wilcoxon rank sum test were used to evaluate continuous variables. RESULTS: Between 2001-2012, an estimated 69,049 ICs and 6,991 CDs were performed. The total number of CDs increased from 2001 to 2012 (p < 0.0001), but peaked in 2008 and subsequently declined every year thereafter. Patients of all ages received ICs at a higher rate than CDs (Table 1), including younger age groups (40-59 and 60-69). Males and Caucasians were more likely to have CD compared to females (p<0.001) and African Americans (p<0.0001), respectively. The rate of CDs was highest in the West (12.1%, p<0.001), at urban teaching centers (10.85%, p<0.001), and in large hospitals (9.71%, p<0.001). On logistic regression analysis, when accounting for age, gender, comorbidities, and hospital characteristics, ICs were associated with higher rates of overall (OR 1.06, p¼0.0185) and infectious (OR 1.13, p¼0.002) complications and in-hospital mortality (OR 1.87, p<0.0001). There was no difference in LOS between the two groups. CONCLUSIONS: The number of CDs performed has declined since 2008. Patients of all ages, including young patients, are more likely to receive IC than CD. Gender, socioeconomic factors, and geographic location may influence diversion type. CDs are associated with comparable rates of complications and in-hospital mortality. Potential causes for declining incidence of continent diversions may include physician reimbursement, length of surgical time, and higher incidence of robotic surgery. These factors should be the subject for further study.
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
RESULTS: Our decision support tool generates a forecasted probability of readmission as well as suggested follow-up frequencies. Sample screenshots from the tool are presented in the Figure. After inputting the date of hospital discharge and other patient characteristics, the app tracks the status of the patient, suggests an optimal follow-up strategy, provides patients with the ability to contact their provider by phone, and tracks future appointments. CONCLUSIONS: We integrated a delay-time analysis methodology into a software tool that can run on personal computers, iPads and iPhones to improve follow-up of patients after radical cystectomy. This software generates real-time predictions of the likelihood of readmission and indicates when future follow-up should be performed, so as to identify clinical deterioration in a timely manner. Through further customization and pilot testing, this decision support tool will enable personalized follow-up to help prevent hospital readmission after radical cystectomy.
Source of Funding: none Source of Funding: None
MP04-06
MP04-07
PERSONALIZED DECISION SUPPORT TOOL TO PREVENT HOSPITAL READMISSION FOR PATIENTS TREATED WITH RADICAL CYSTECTOMY
PROGNOSTIC IMPACT OF IMMUNOHISTOCHEMICAL CLASSIFICATION OF BLADDER CANCER ACCORDING TO LUMINAL (UROPLAKIN III) AND BASAL (CYTOKERATIN 5/6) MARKERS
Sarah Finley, Shivani Joshi*, Tudor Borza, Xiang Liu, Ted A. Skolarus, Ann Arbor, MI; Bruce L. Jacobs, Pittsuburgh, PA; Benjamin Y. Li, Ann Arbor, MI; Heather Jim, Scott M. Gilbert, Tampa, FL; Zhitong Xie, Ann Arbor, MI; Jonathan E. Helm, Bloomington, IN; Mariel S. Lavieri, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: To create a userfriendly, personalized decision support tool that can display the likelihood of readmission after radical cystectomy, as well as recommendations for optimal follow-up based on published data. METHODS: We developed the “REACT: Readmission Elimination App for Cystectomy Treatment” using Apple’s Xcode. This tool uses delay-time analysis models to determine the optimal timing of office visits and phone calls in order to maximize the probability of detecting radical cystectomy patients susceptible to readmission. We calibrated and validated the tool using radical cystectomy patient data from the 2009-2010 Healthcare Cost and Utilization Project State Inpatient Databases, and our institution’s bladder cancer database from 2007 to 2011, as published in J Urol. 2016 May;195(5):1362-7.
Tetsutaro Hayashi*, Kazuhiro Sentani, Shinji Kakumoto, Hiroshima, Japan; Htoo Zarni Oo, Vancouver, Canada; Naoya Sakamoto, Hiroshima, Japan; Kazuaki Mutaguchi, Nakatsu, Japan; Kohei Kobatake, Keisuke Goto, Shogo Inoue, Jun Teishima, Hiroshima, Japan; Peter Black, Vancouver, Canada; Akio Matsubara, Hiroshima, Japan INTRODUCTION AND OBJECTIVES: Recent genomic studies suggest that urothelial carcinoma (UC) can be grouped into luminal and basal subtypes. Basal bladder cancers are enriched with squamous features and are associated with worse prognosis. Previously, we reported that Desmocollin2 (DSC2) is an immunohistochemical (IHC) marker of squamous differentiation (SD) in UC, that correlates significantly with advanced tumor stage and poor prognosis. Here, we examined the subtype classification of bladder cancer based on Uroplakin III (UPK3) and Cytokeratin 5/6 (CK5/6) expression. METHODS: Expression of UPK3, CK5/6 and DSC2 was measured by IHC in 57 cases of bladder cancer treated with cystectomy
THE JOURNAL OF UROLOGYâ
mortality, length of stay (LOS), and total cost after radical cystectomy with IC vs CD were compared. Chi square test and multivariable logistic regression were used to analyze patient and hospital characteristics. Student’s t-test and Wilcoxon rank sum test were used to evaluate continuous variables. RESULTS: Between 2001-2012, an estimated 69,049 ICs and 6,991 CDs were performed. The total number of CDs increased from 2001 to 2012 (p < 0.0001), but peaked in 2008 and subsequently declined every year thereafter. Patients of all ages received ICs at a higher rate than CDs (Table 1), including younger age groups (40-59 and 60-69). Males and Caucasians were more likely to have CD compared to females (p<0.001) and African Americans (p<0.0001), respectively. The rate of CDs was highest in the West (12.1%, p<0.001), at urban teaching centers (10.85%, p<0.001), and in large hospitals (9.71%, p<0.001). On logistic regression analysis, when accounting for age, gender, comorbidities, and hospital characteristics, ICs were associated with higher rates of overall (OR 1.06, p¼0.0185) and infectious (OR 1.13, p¼0.002) complications and in-hospital mortality (OR 1.87, p<0.0001). There was no difference in LOS between the two groups. CONCLUSIONS: The number of CDs performed has declined since 2008. Patients of all ages, including young patients, are more likely to receive IC than CD. Gender, socioeconomic factors, and geographic location may influence diversion type. CDs are associated with comparable rates of complications and in-hospital mortality. Potential causes for declining incidence of continent diversions may include physician reimbursement, length of surgical time, and higher incidence of robotic surgery. These factors should be the subject for further study.
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
RESULTS: Our decision support tool generates a forecasted probability of readmission as well as suggested follow-up frequencies. Sample screenshots from the tool are presented in the Figure. After inputting the date of hospital discharge and other patient characteristics, the app tracks the status of the patient, suggests an optimal follow-up strategy, provides patients with the ability to contact their provider by phone, and tracks future appointments. CONCLUSIONS: We integrated a delay-time analysis methodology into a software tool that can run on personal computers, iPads and iPhones to improve follow-up of patients after radical cystectomy. This software generates real-time predictions of the likelihood of readmission and indicates when future follow-up should be performed, so as to identify clinical deterioration in a timely manner. Through further customization and pilot testing, this decision support tool will enable personalized follow-up to help prevent hospital readmission after radical cystectomy.
Source of Funding: none Source of Funding: None
MP04-06
MP04-07
PERSONALIZED DECISION SUPPORT TOOL TO PREVENT HOSPITAL READMISSION FOR PATIENTS TREATED WITH RADICAL CYSTECTOMY
PROGNOSTIC IMPACT OF IMMUNOHISTOCHEMICAL CLASSIFICATION OF BLADDER CANCER ACCORDING TO LUMINAL (UROPLAKIN III) AND BASAL (CYTOKERATIN 5/6) MARKERS
Sarah Finley, Shivani Joshi*, Tudor Borza, Xiang Liu, Ted A. Skolarus, Ann Arbor, MI; Bruce L. Jacobs, Pittsuburgh, PA; Benjamin Y. Li, Ann Arbor, MI; Heather Jim, Scott M. Gilbert, Tampa, FL; Zhitong Xie, Ann Arbor, MI; Jonathan E. Helm, Bloomington, IN; Mariel S. Lavieri, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: To create a userfriendly, personalized decision support tool that can display the likelihood of readmission after radical cystectomy, as well as recommendations for optimal follow-up based on published data. METHODS: We developed the “REACT: Readmission Elimination App for Cystectomy Treatment” using Apple’s Xcode. This tool uses delay-time analysis models to determine the optimal timing of office visits and phone calls in order to maximize the probability of detecting radical cystectomy patients susceptible to readmission. We calibrated and validated the tool using radical cystectomy patient data from the 2009-2010 Healthcare Cost and Utilization Project State Inpatient Databases, and our institution’s bladder cancer database from 2007 to 2011, as published in J Urol. 2016 May;195(5):1362-7.
Tetsutaro Hayashi*, Kazuhiro Sentani, Shinji Kakumoto, Hiroshima, Japan; Htoo Zarni Oo, Vancouver, Canada; Naoya Sakamoto, Hiroshima, Japan; Kazuaki Mutaguchi, Nakatsu, Japan; Kohei Kobatake, Keisuke Goto, Shogo Inoue, Jun Teishima, Hiroshima, Japan; Peter Black, Vancouver, Canada; Akio Matsubara, Hiroshima, Japan INTRODUCTION AND OBJECTIVES: Recent genomic studies suggest that urothelial carcinoma (UC) can be grouped into luminal and basal subtypes. Basal bladder cancers are enriched with squamous features and are associated with worse prognosis. Previously, we reported that Desmocollin2 (DSC2) is an immunohistochemical (IHC) marker of squamous differentiation (SD) in UC, that correlates significantly with advanced tumor stage and poor prognosis. Here, we examined the subtype classification of bladder cancer based on Uroplakin III (UPK3) and Cytokeratin 5/6 (CK5/6) expression. METHODS: Expression of UPK3, CK5/6 and DSC2 was measured by IHC in 57 cases of bladder cancer treated with cystectomy