Outcomes of Nephrolithiasis Care by Patients' Race: From a Statewide Quality Improvement Collaborative

Objectives Kidney stone disease, or nephrolithiasis, is a condition that is prevalent amongst the population in the United States. The state of Kentucky is part of the "Kidney Stone Belt", which has the highest prevalence of kidney stones in the United States. Although kidney stone formation is multifactorial, efforts must be made by urologists in the Kidney Stone Belt to provide consistent care that is in accordance with American Urological Association (AUA) guidelines. To implement quality improvement measures in nephrolithiasis care, our study first aims to reveal inadequacies of our approach to care today.  Methods  We completed retrospective chart reviews of patients with nephrolithiasis from 13 urologists affiliated with two academic medical institutions. Individual data points were collected for each patient and stored in a database. The data was analyzed and tested for statistical significance using the Chi-squared test and stratified by race.  Results Upon analysis of our data, we noted statistically significant racial differences in the following areas of nephrolithiasis care: post-lithotripsy stone analysis, orders for 24-hour urine tests, and dietary histories. Although not statistically significant, our population, regardless of race, had little to no documentation of physician-led counseling for kidney stone prevention. Conclusions Our analysis identifies several areas where patients could benefit from quality improvement measures in nephrolithiasis care. We recommend adherence to AUA guidelines for the medical management of nephrolithiasis care to prevent compromise of the quality of care provided to racial minority patients. Additionally, social determinants of health may have a role to play in disparities noted in this study.