ArticleUrology2026
Claims-based Approach to Defining Renal Colic Episodes: Implications for Researchers, Providers, and Policymakers.
Article in Urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo define renal colic episodes more accurately using a novel claims-based method and evaluate how clinical and nonclinical factors, including insurance type, affect rates of surgical intervention and Emergency Department (ED) revisits, as well as episode-related expenditures. Traditional fixed-window episode definitions may misclassify care duration and intensity, limiting their utility in assessing real-world utilization.
methodsWe analyzed 2016-2019 claims data from North Carolina Medicaid and a large private insurer to identify adults aged 18-64 with an ED visit for renal colic (N = 65,346). Episodes were defined using statistically significant deviations in weekly healthcare charges. Multivariable binary and ordered logistic regression assessed associations between patient characteristics, pharmacotherapy, provider follow-up, and three outcomes: definitive surgery, 30-day ED revisit, and total episode charges.
resultsAmong patients undergoing surgery, episode duration averaged 10 weeks for privately insured and 6 weeks for Medicaid patients. Among nonsurgical patients, episode duration averaged 4 weeks for both groups. Earlier post-ED ambulatory urology follow-up reduced odds of 30-day revisit (private: OR 0.37, P < .0001; Medicaid: OR 0.29, P < .0001). Alpha blocker prescription at the time of ED discharge was associated with lower 30-day revisit risk (private: OR 0.80, P < .0001; Medicaid: OR 0.83, P < .001). 30-day ED revisit was associated with higher episode-specific expenditures, regardless of surgical/insurance status.
conclusionWe employed a novel claims-based approach to renal colic episode definition, which revealed nuances in care utilization and access driven by potentially modifiable factors like insurance status and timing of post-ED ambulatory follow-up.
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