# Defining Optimal Care for Urinary Stone Disease in the Veterans Health Administration

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2022 · —

## Abstract

Background: Urinary stone disease (USD) imposes a major economic and health burden on
the United States and the Veterans Health Administration (VHA). Current barriers to delivering
optimal health care to patients with USD include the dearth of evidence-based process measures
and treatments and the complexity of secondary prevention measures for USD.
Significance/Impact: Current guidelines for best practice management of USD are largely
based on clinical principles or expert opinion. The relative lack of evidence-based guidelines
may lead to suboptimal care and drive unwanted practice pattern variability of quality of care for
USD. The proposed research will address the following VHA/ORD priorities: Primary care
practice and management of complex chronic diseases (such as recurrent USD) and quality
measurement of USD prevention.
Innovation: The proposed research will determine which guideline-recommended strategies
are effective for secondary prevention of USD. Randomized clinical trials are not yet on the
horizon, and so our findings hold the promise of rapidly expanding the evidence base for
optimal care of USD and shift the clinical practice paradigm for USD towards primary care
providers so that more Veterans with USD can receive effective stone prevention.
Specific Aims: We propose the following specific aims: 1) Determine which prevention
measures are associated with lower rates of USD recurrence in the VHA; 2) Evaluate how VHA
providers are currently implementing prevention measures for USD; and 3) Identify current
barriers to implementing effective prevention measures for USD in the VHA. We hypothesize
the following: 1) prevention measures such as screening for primary hyperparathyroidism, 24-
hour urine testing, and prescription of stone-related medications are associated with longer
periods of time to recurrent USD and/or fewer stone events; 2) primary care providers are less
likely than specialty providers to implement prevention measures for USD; and 3) each provider
type face unique barriers that reduce utilization of effective stone prevention measures.
Methodology: Aim 1 will identify a national cohort of Veterans with incident or recurrent USD
between 2010 and 2016 and use methods that mimic randomized clinical trials to identify which
guideline-recommended measures lead to longer times to a second USD event or fewer USD
events. Aim 2 will examine the proportion of patients who receive care from primary care,
nephrology, and urology providers following their index stone event and identify which
providers are more or less likely to implement each prevention measure. Aim 3 will conduct
national surveys with primary care, nephrology, and urology providers affiliated with the VHA
to identify barriers to implementation of effective stone prevention measures.
Next Steps/Implementation: The VHA is ideally positioned to support comparative
effectiveness studies to determine which best practice guidelines are most effective at reducing
USD ...

## Key facts

- **NIH application ID:** 10229348
- **Project number:** 5I01HX003091-02
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** John Thomas Leppert
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10229348

## Citation

> US National Institutes of Health, RePORTER application 10229348, Defining Optimal Care for Urinary Stone Disease in the Veterans Health Administration (5I01HX003091-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10229348. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*