1. EMBARGOED FOR RELEASE UNTIL SATURDAY, MAY 14, 2011 AT 12:30 P.M.
Contact: Wendy Waldsachs Isett, AUA
410-977-4770, wisett@AUAnet.org
PANEL TO ADDRESS KEY PUBLIC HEALTH CONCERNS IN UROLOGY
Washington, DC, May 14, 2011—Patient access to care, the role of telemedicine and quality issues are all key
tenets in today’s healthcare debate, and five new studies being presented during the 2011 Annual Meeting of the
American Urological Association will provide valuable data that will contribute to the national discussion. A special
panel press briefing, to be moderated by Tomas L. Griebling, MD, MPH, will be held on Saturday, May 14 at 12:30
p.m. to highlight the data from these studies, which include:
Urologic Cancer Mortality Rates Stratified by Geographic Region and Physician Prevalence in the United States
(#50): Physician density may correlate to ease of care for patients and translate ultimately into worse outcomes
for certain urologic cancers, according to researchers at Tulane University. Using data from the Center for Disease
Control and Prevention’s (CDC) National Vital Statistics System, study authors examined age-adjusted annual
mortality rates for prostate (PCa), bladder (BCa) and renal and pelvis cancers (RCa) from 2003-2007, comparing it
with data from the U.S. Census Bureau that provided key information on the number of physicians, population,
health insurance status, poverty level and median family income. Data from the counties with the highest
mortality rates for these designated cancers were compared to those with the lowest death rates. Key findings
included a significantly higher rate of RCa mortality in areas with low physician density, as well as a negative – and
statistically significant – association between median family income as it relates to BCa and RCa.
New Care Coordination System Improves the Quality, Efficiency and Cost of Care for Patients with Hematuria
(#314): Patients with blood in their urine (hematuria) may benefit from a care coordination system that helps
ensure a complete referral to and evaluation by a urologist in a timely manner that may also result in fewer
patient visits and cost savings overall, according to Northwestern University researchers, who will present a
standardized “Hematuria Pathway” checklist to better guide primary care physicians’ assessment and referral of
patients to urologists. According to the protocol, patients with hematuria should be provided both an order for a
CT scan and a urology referral with cystoscopy as they transition from their primary care physician to a urologist
(as opposed to receiving the CT order and cystoscopy referral during their initial visit with their urologist). Patients
who were evaluated using this protocol were fully evaluated in a shorter amount of time that those who were not,
and were able to complete their urology evaluation in a single visit. Given that an estimated 500,000 to 1 million
hematuria evaluations are performed in the United States each year, removing this initial visit could save an
estimated $50 million to $100 million per year, in addition to improving patient access to timely, quality care.
Urology Practices and Readiness for Medical Home Reforms (#81): Specialty practices – including urology
practices -- are well positioned to serve as optimal medical homes for some patients, according to a new analysis
by researchers at the University of Michigan in Ann Arbor. Using items from the 2007 and 2008 National
Ambulatory Medical Care Surveys (NAMCS) and specific elements in the National Committee on Quality Assurance
(NCQA) medical home standards, researchers examined the structural readiness of specialty practices, awarded

2. points for each element passed, calculated scores and then estimated the proportion of practices that would
currently achieve medical home status. Estimates were compared for urology vs. other surgical specialties vs.
medical specialties. Urology practices outperformed other surgical and medical specialty practices on 10 out of 15
elements, including a higher percent of “must pass” elements (45.2 percent vs. 33.7 percent vs. 31.5 percent,
respectively). Nearly three quarters of urology practices meet the NCQA standards for medical home recognition,
compared to just half of other medical and surgical specialty practices.
NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange an
interview with an expert, please contact the AUA Communications Office at the number above or e-mail
wisett@AUAnet.org.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American
Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members throughout
the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic
care by carrying out a wide variety of programs for members and their patients.
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3. 626
THE IMPACT OF OAB ON WORK PRODUCTIVITY IN THE US: RESULTS FROM OAB-POLL
Chris C. Sexton, Karin S. Coyne, Jill Bell, J. Quentin Clemens, Roger Dmochowski, Chieh-I Chen, Tamara Bavendam,
Zoe Kopp, Bethesda, MD
INTRODUCTION AND OBJECTIVES: The impact of OAB on work productivity is not well-known. OAB-POLL
evaluated OAB and work productivity in a large community sample with an overrepresentation of minorities.
METHODS: This cross-sectional, population-representative survey was conducted via the Internet in the US among
men and women age 18-70 in July and Aug, 2010. The LUTS tool, developed based on ICS definitions and
qualitative research, was used to assess the frequency and bother of urinary symptoms during the past 4 weeks on
a 5-point Likert scale. OAB was defined by the presence of urinary urgency ? "sometimes" or ? "often" and/or the
presence of urgency urinary incontinence (UUI). Responses of those with OAB were compared to those with
no/minimal symptoms (NMS) using descriptive statistics; analyses were conducted among men and women
separately. Outcomes include work status, the Work Productivity and Activity Impairment Questionnaire-General
Health and Specific Health Problems adapted for urinary symptoms (WPAI-GH/SHP) and a modified version of the
Work Limitations Questionnaire (mWLQ). Logistic regressions evaluated predictors of employment status (yes/no)
adjusting controlling for demographics, risk factors, and comorbid conditions.
RESULTS: Overall response rate was 56.7%; 10,000 men and women participated; mean age was 41.8. Using the
OAB ? "sometimes" definition, men and women with NMS were significantly more likely to be currently working
compared to those with OAB (Men: 76% vs. 57%, women: 59% vs. 45%, p<0.0001). The mean % overall work
impairment due to general health problems was 19% and 21% among men and women with OAB versus 4% in
men and 7% in women with NMS (p<0.0001). Mean % activity impairment due to general health problems: men
and women with OAB, 22% and 24%; men and women with NMS, 5% and 7% (p<0.0001). Similar patterns were
found with scores on the WPAI-SHP and mWLQ. Results using the OAB ? "often" definition were similar but
reflected greater work impairment. OAB was significantly (p<0.01) associated with being currently unemployed
among men but not women.
CONCLUSIONS: Men and women with OAB report significantly greater levels of work limitations as compared to
those without urinary symptoms. Furthermore, mean percentages of overall work impairment from this study
were nearly twice that found in a prior population-based study (EPIC) and were similar to those found in asthma
(20%) and rheumatoid arthritis (24%).
Source of Funding: Pfizer Inc.

4. 50
UROLOGIC CANCER MORTALITY RATES STRATIFIED BY GEOGRAPHIC REGION AND PHYSICIAN PREVALENCE IN
THE UNITED STATES
Janet Colli, MD, Leah Grossman, Oliver Sartor, MD, Benjamin R Lee, MD, New Orleans, LA
INTRODUCTION AND OBJECTIVES: The risks and benefits of early detection of urologic cancers, especially
prostate cancer, are controversial. The study purpose is to examine the association between urologic cancer
mortality rates and the ease of access to medical care correlated to density of physicians. We hypothesize that
cancer mortality rates increase with low populations of physicians among the general public since this would
decrease access to medical care and reduce screening to identify cancers at an early stage.
METHODS: Age-adjusted annual mortality rates for prostate cancer (PCa), bladder cancer (BCa) and renal & pelvis
cancer (RCa) for Caucasians in U.S. counties from 2003 to 2007 provided by the National Vital Statistics System of
the Centers for Disease Control and Prevention were obtained for this study. Data on the number of physicians
(858,490); population of the general public (290,210,914); the percentage of persons without health insurance;
the percentage living below the poverty level and median family income were obtained from the U.S. Census
Bureau. High and low cancer rate groups were the formed for the analysis in this study. Counties with the 25
highest mortality rates for PCa, BCa and RCa were selected for the high rate group. The low rate group consisted
of counties, selected from the same states as the high rate group, with the lowest rates. Population densities of
physicians per 10,000 general population, and factors related to access to medical care were compared between
the high and low groups.
RESULTS: Annual
High cancer mortality rate group Low cancer mortality rate group
deaths rates and
PCa mortality 47.9 (95% CI = 45.1/50.7) 16.1 (95% CI = 19.0/17.5)
the independent
Physician population density 11.8 (95% CI = 7.8/15.9) 28.8 (95% CI = 11.7/45.8)
variables for the
No health insurance 19.0% (95% CI = 16.3/21.5) 17.6% (95% CI =15.1/20.0)
high and lowPoverty 12.6% (95% CI = 10.7/14.5) 10.2% (95% CI = 9.1/11.3)
cancer mortality income ($)
Family $41,137 (95% CI=$38,144/44,131) $46,177 (95% CI=$43,392/48,961)
rate groups are mortality
BCa 8.6 (95% CI = 8.3/9.0) 3.6 (95% CI = 3.4/3.8)
provided in thePhysician population density 17.1 (95% CI = 11.7/22.4) 33.3 (95% CI = 21.5/45.1)
Table below.No health insurance (%) 18.8 (95% CI = 16.9/20.7) 18.4 (95% CI = 16.6/20.2)
(Statistically Poverty (%) 12.1(95% CI = 10.4/13.9) 10.2 (95% CI = 8.2/12.2)
significant Family income ($) $42,664 (95% CI=$39,809/45,519) $49,733 (95% CI = $45,596/53,870)
differences RCa mortality 8.5 (95% CI = 8.1/8.9) 3.4 (95% CI = 3.2/3.6)
between groups Physician population density 14.0 (95% CI=10.0/18.1) 42.2 (95% CI=24.1/60.3)
are in bold.) No health insurance (%) 17.7 (95% CI = 15.2/20.1) 17.7 (95% CI = 15.4/20.0)
Poverty (%) 12.4 (95% CI = 10.5/14.3) 9.9 (95% CI = 8.2/11.7)
Family income ($) $42,515 (95% CO=$39,340/45689) $53,350 (95% CI= $48,747/57,953
CONCLUSIONS: RCa cancer mortality rates are increased significantly with low population density of physicians
among the general public. This potentially is a result of decreased access to medical care and reduced testing to
diagnose RCa at an early stage. We found a suggestive but not significant negative association between the
prevalence of physicians and mortality rates for PCa and BCa. There was also a negative association between
median family income that was statistically significant for BCa and RCa and suggestive for PCa.
Source of Funding: None

5. 314
NEW CARE COORDINATION SYSTEM IMPROVES THE QUALITY, EFFICIENCY AND COST OF CARE FOR PATIENTS
WITH HEMATURIA
Jessica T. Casey, John Cashy, Amy Tourne-Schwab, Nilmini Wickramasinghe, Anthony J. Schaeffer, Christopher M.
Gonzalez, Lyle L. Berkowitz, Chicago, IL
INTRODUCTION AND OBJECTIVES: As microscopic and gross hematuria are common urologic referrals with a
defined best practice pathway for evaluation, we sought to determine if inclusion of a care coordination system to
manage the referral process would lead to improved quality, efficiency and economic outcomes.
METHODS: A care coordination system was developed which included the primary care physician?s use of a
standardized ?Hematuria Pathway? checklist which included orders for a CT scan followed by a urology referral
with cystoscopy. A care coordinator facilitated the ordering process and reviewed the progress at 4 weeks to
ensure completion. This system was used for patients referred for hematuria from May 2009 to May 2010. The
outcomes for these ?navigated? patients (group A, n=106) were compared to patients referred to our urology
department for hematuria during the same time period who did not use a care coordination system (group B,
n=105).
RESULTS: Demographics, presenting symptoms, and final diagnoses were equal between groups, and there was no
significant difference in the percentage of patients who completed the entire hematuria work-up (55.7% A vs.
47.6% B, p=0.24) or were seen by urology (84.0% A vs. 77.1% B, p=0.21). However, patients in group A completed
their evaluation in significantly shorter times with decreased time between the diagnosis of hematuria and
completion of the CT scan (22.0 vs. 45.2 days, p<0.05) and completion of cystoscopy (35.8 vs. 70.6 days, p<0.05).
Additionally, more patients in group A had their CT scan completed prior to their first urology visit (75.5% vs.
28.6%, p<0.05). Also, group A had more patients who completed their evaluation in one urology visit (56.6% vs.
21.9%, p<0.05).
CONCLUSIONS: Incorporating a care coordination system into the referral process for hematuria decreased the
time to complete evaluation. Timeliness, one of the Institute of Medicine?s quality metrics, is particularly
important for this situation as 3.8% of patients had a new cancer diagnosis. Additionally, increasing the number of
CT scans done prior to the first urology visit resulted in less total urology visits per evaluation. This finding should
result in decreased cost to patients and payors, as well as increased access to care for others as more
appointments will be open. It is estimated there are 500,000 to 1,000,000 hematuria evaluations per year in the
U.S., so removing an initial visit with a cost of $100 could save the healthcare system approximately $50 to $100
million per year. Further analysis of the economic and quality ramifications of this care coordination system is
under way.
Source of Funding: Szollosi Healthcare Innovation Program, Grant Healthcare Foundation

6. 81
UROLOGY PRACTICES AND READINESS FOR MEDICAL HOME REFORMS
John M. Hollingsworth, Joseph W. Sakshaug, David C. Miller, Ann Arbor, MI
INTRODUCTION AND OBJECTIVES: The degree to which existing physician practices possess the ?structural
readiness? to function as medical homes has been incompletely examined. Prior evaluations have focused mainly
on primary care practices. As there are certain conditions for which specialty practices might be the optimal
medical home (e.g., urology practices for men with prostate cancer), there is also a need to better understand the
current infrastructure in these settings.
METHODS: We mapped items from the 2007 and 2008 National Ambulatory Medical Care Surveys (NAMCS) to
specific elements in the National Committee on Quality Assurance (NCQA) standards for medical home
recognition. We awarded points to a practice for each NCQA element that it passed. We then calculated a
practice?s ?structural readiness? score by dividing its point total by the available number. Finally, we estimated
the proportion of physician practices that would achieve medical home status according to clinical specialty (i.e.,
urology versus other surgical specialty versus medical specialty).
RESULTS: Urology practices outperformed other surgical and medical specialty practices on ten of 15 measured
elements. Moreover, urology practices achieved a higher percent of ?must pass? elements (45.2% versus 33.7
versus 31.5%, respectively; P<0.001). Nearly three quarters of urology practices meet current NCQA standards for
medical home recognition, as compared to just half of other surgical and medical specialty practices (Table).
CONCLUSIONS: Our findings indicate that the majority of urology practices possess the ?structural readiness? for
implementation of proposed medical home reforms.
Source of Funding: Robert Wood Johnson Foundation Clinical Scholars Program