Integration of Advanced Practice Providers into Independent Surgical Groups.

Background: Nurse practitioners and physician assistants are increasingly employed to extend surgeon capacity and access. However, their roles and the extent to which their deployment aligns with unmet need is unknown.

Study Design: Medicare data was used to identify patients managed by surgical groups (urologists, and orthopedic, general, and cardiothoracic surgeons) from 2010-2020.

Carbon Emissions From Patient Travel for Health Care.

Importance: The US health care sector accounts for about 8.5% of national greenhouse gas (GHG) emissions. Reliable estimates of emissions associated with health care-related travel are essential for informing policy changes.

Impact of a Large-Scale Remote Patient Monitoring Program on Hospitalization Reduction.

Patient Monitoring at Home is a Remote Patient Monitoring (RPM) program through Michigan Medicine, which provides symptoms and vital sign monitoring via a provided cellular tablet and Bluetooth-connected devices. A team of registered nurses monitors patients 7 days per week. The team examined 6-month outcomes for 1,139 encounters from November 2020 to August 2022, which showed a 59% reduction in the average number of hospital admissions 6 months after the start of enrollment (1.

Primary Care Practice Telehealth Use and Low-Value Care Services.

Importance: The rapid expansion of telehealth transformed how primary care practices deliver care; however, uncertainties about the quality of telehealth-delivered care compared with in-person care remain. While there are concerns that increased telehealth may introduce wasteful care, how telehealth affects the delivery of low-value care is unknown.

Objective: To examine whether a primary care practice's level of telehealth use is associated with changes in the rates of low-value care.

Telehealth visit type and patient-reported outcomes among patients with cancer.

Background: Relaxed licensing restrictions on telehealth use during the COVID-19 pandemic allowed broad use irrespective of visit type. As these telehealth waivers expire, optimal uses of telehealth must be assessed to inform policy and clinical care. We evaluated patient experience associated with telehealth and in-person new or established visits.

Attitudes and barriers toward video visits in surgical care: Insights from a nationwide survey among surgeons.

Background: Surgeons rapidly adopted video visits during the COVID-19 pandemic. However, video visit use among surgeons has significantly declined, pointing to the need to better understand current attitudes and barriers to their use in surgical care.

Methods: From August 2022 to March 2023, a nationwide survey was conducted among practicing surgeons in 6 specialties.

Telemedicine in urologic oncology care: Will telemedicine exacerbate disparities?

Introduction: Disparities in prostate, bladder, and kidney cancer outcomes are associated with access to care. Telemedicine can improve access but may be underutilized by certain patient populations. Our objective was to determine if the patient populations who suffer worse oncologic outcomes are the same as those who are less likely to use telemedicine.

Perceived vs Actual Shared Decision-Making Behavior Among Urologists: A Convergent, Parallel, Mixed-Methods Study of Self-Reported Practice.

Objective: To evaluate the association between self-perceived use of shared decision-making among urologists with use of validated prediction tools and self-described surgical decision-making.

Methods: This is a convergent mixed methods study of these parallel data from two modules (Shared Decision Making and Validated Prediction tools) within the 2019 American Urological Association (AUA) Annual Census. The shared decision-making (SDM) module queried aspects of SDM that urologists regularly used.

Interstate Telemedicine for Urologic Cancer Care.

Purpose: US states eased licensing restrictions on telemedicine during the COVID-19 pandemic, allowing interstate use. As waivers expire, optimal uses of telemedicine must be assessed to inform policy, legislation, and clinical care. We assessed whether telemedicine visits provided the same patient experience as in-person visits, stratified by in- vs out-of-state residence, and examined the financial burden.

Intra-practice Urologist-level Variation in Targeted Fusion Biopsy Outcomes.

Objective: To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy.

Methods: All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score.

Predictors of Video versus Audio-Only Telehealth Use among Urological Patients.

Introduction: During the COVID-19 public health emergency, telehealth use grew due to regulatory and reimbursement surrounding the use of video and audio-only visits for the evaluation and management of patients.

Methods: We retrospectively reviewed patients seeking outpatient urological care from April 1, 2020 to June 30, 2020 at a urological tertiary care center. Our study was designed to determine the relative effect of demographic, socioeconomic and geographic variables on the likelihood of using video compared to an audio-only telehealth.

The Lack of a Physical Exam During New Patient Telehealth Visits Does Not Impact Plans for Office and Operating Room Procedures.

Objective: To understand how the lack of a physical examination during new patient video visits can impact urological surgery planning during the COVID-19 pandemic.

Methods: We retrospectively reviewed 590 consecutive urology patients who underwent new patient video visits from March through May 2020 at a single academic center. Our primary outcome was procedural plan concordance, the proportion of video visit surgical plans that remained the same after the patient was seen in-person, either in clinic or on day of surgery.

Factors Associated with Decision Aid Use in Localized Prostate Cancer.

Purpose: Decision aids have been found to improve patients' knowledge of treatments and decrease decisional regrets. Despite these benefits, there is not widespread use of decision aids for newly diagnosed prostate cancer (PCa). This analysis investigates factors that impact men's choice to use a decision aid for newly diagnosed prostate cancer.

The Role of Social Support in Telehealth Utilization Among Older Adults in the United States During the COVID-19 Pandemic.

Older adults may experience a significant digital divide and need support with using technology to transition to telehealth. This study examines the role of social support for telehealth utilization among older adults during the COVID-19 pandemic. We used data from the COVID-19 Sample Person Interview to the National Health and Aging Trends Study.

Interstate Telehealth Use By Medicare Beneficiaries Before And After COVID-19 Licensure Waivers, 2017-20.

During the COVID-19 pandemic, all fifty states and Washington, D.C., passed licensure waivers that allowed patients to participate in telehealth visits with out-of-state clinicians (that is, interstate telehealth).

Association Between Primary Care Practice Telehealth Use and Acute Care Visits for Ambulatory Care-Sensitive Conditions During COVID-19.

Importance: During the COVID-19 pandemic, many primary care practices adopted telehealth in place of in-person care to preserve access to care for patients with acute and chronic conditions. The extent to which this change was associated with their rates of acute care visits (ie, emergency department visits and hospitalizations) for these conditions is unknown.

Objective: To examine whether a primary care practice's level of telehealth use is associated with a change in their rate of acute care visits for ambulatory care-sensitive conditions (ACSC visits).

Assessing the Impact of Decision Aid Use on Post Prostatectomy Patient Reported Outcomes.

Objective: To evaluate whether completing a decision aid, Personal Patient Profile - Prostate (P3P), prior to prostatectomy, affects self-reported bother from post-prostatectomy urinary incontinence and erectile dysfunction.

Materials And Methods: This retrospective analysis included data from men with newly diagnosed clinically localized, very low to intermediate risk prostate cancer who elected for prostatectomy within the Michigan Urological Surgery Improvement Collaborative between 2018-2021. Multivariable logistic regression models were used to estimate the association between P3P use and bother from post prostatectomy erectile dysfunction and urinary incontinence as measured by the Expanded Prostate Cancer Index Composite (EPIC-26).

Telehealth Use Before and During the COVID-19 Pandemic Among Children with Sickle Cell Anemia.

Sickle cell anemia (SCA) is a genetic condition that predominantly affects minority populations in the United States. A lack of access to care is strongly associated with poor outcomes and quality of care among children and adolescents with SCA. The use of telehealth, which has rapidly expanded during the COVID-19 pandemic, has been shown to improve access to care for many conditions.