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PD23-12 HEMATURIA PRACTICE PATTERNS IN THE PRIMARY CARE SETTING
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
whites and men, portending inferior survival. Lower use of timely and complete hematuria evaluation may underlie these differences. METHODS: We used self-reported data from the Southern Community Cohort Study (SCCS), a cohort of 86,000 persons accrued from community health clinics in the Southeast, focusing on the 48% who also had administrative data from Medicare linkage. Included subjects were diagnosed with incident hematuria in the primary care setting at age > 40, without pre-existing diagnoses that cause hematuria. Evaluation was considered complete if both abdomino-pelvic imaging and cystoscopy were performed within 180 days of hematuria diagnosis. Exposures of interest were race, gender, and risk factors for bladder cancer (age, smoking history and high-risk occupation). Multivariable models with interaction terms were fit to identify differences in evaluation among race/gender groups (RGG) and to determine whether risk factors predicted completeness of evaluation within each RGG. RESULTS: Among 1412 patients (60% AA; 64% female; median age 59), imaging was performed in 41-47% of cases, cystoscopy in 18-25%, and evaluation was complete in 15-23%, depending on RGG. On multivariable analysis, referral to urology was influenced by the number of risk factors in men (OR 1.66 [1.08, 2.55] p¼0.02), but not women (OR 1.18 [0.86, 1.61] p¼0.31) (figure). Use of imaging and cystoscopy were unrelated to number of risk factors in all RGGs. Complete evaluation was significantly lower in AA patients compared to whites (OR 0.65 [0.48, 0.89] p¼0.007), due to lower use of imaging (OR 0.74 [0.58, 0.94] p¼0.01) and cystoscopy (OR 0.66 [0.49, 0.89] p¼0.01). Gender differences in these outcomes were not significant. CONCLUSIONS: About 20% of patients in each RGG underwent complete evaluation. Number of risk factors predicted referral to urology among men, but was otherwise a poor predictor of evaluation. The likelihood of complete evaluation and each component thereof was lower in AA patients compared to whites; gender differences were smaller and nonsignificant. Increasing use of timely and complete evaluation for hematuria may reduce racial variation in bladder cancer stage at diagnosis.
e485
Source of Funding: NCI 1R03CA173807
PD23-12 HEMATURIA PRACTICE PATTERNS IN THE PRIMARY CARE SETTING Lisa Parrillo*, Justin Ziemba, Matthew Sterling, Alida Gertz, Phillip Mucksavage, Thomas Guzzo, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Hematuria is common and therefore the initial patient contact is often with their primary care or an emergency medicine provider. Understanding the practice patterns for the diagnosis and management of hematuria will allow for improved care delivery for patients. METHODS: A 22-question electronic survey was distributed to all 574 attending, fellow, resident, and advanced practice providers in the Internal Medicine, Family Medicine and Emergency Medicine Departments of a large academic health system. The survey assessed current practice patterns of diagnostic imaging, laboratory evaluation, and care coordination for gross and microscopic hematuria. RESULTS: A total of 137 (24%) providers completed the survey. Only 13% (18/135) of respondents were aware of the American Urological Association (AUA) guidelines on asymptomatic microscopic hematuria and only 30% (26/137) appropriately defined microscopic hematuria as a single urinalysis with 3 or more red blood cells per high-power field. A total of 35% of respondents would send a cytology: 15% (20/136) for all patients with hematuria, 12% (16/136) only for those with microscopic hematuria, and 8% (11/136) only for those with gross hematuria. 28% (39/137) of providers send urine cultures on patients with microscopic hematuria and 43% (58/ 136) on those with gross hematuria regardless of urinalysis or symptoms. Consultation with urology would be recommended by 45%, 10%, and 38% (62/137, 14/137, and 52/137) of respondents in all cases of hematuria, only microscopic hematuria, and only gross hematuria, respectively. 93% (127/ 137) felt that a clinical care pathway for the evaluation and management of hematuria would be valuable in their practice. CONCLUSIONS: Primary care providers are unaware of the AUA guidelines on asymptomatic microscopic hematuria. Furthermore, there is variability regarding the appropriate diagnostic imaging, laboratory evaluation, and referral amongst front-line providers. Development of clinical care pathways are desired and may improve adherence to already established evidence based guidelines. Source of Funding: none
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
whites and men, portending inferior survival. Lower use of timely and complete hematuria evaluation may underlie these differences. METHODS: We used self-reported data from the Southern Community Cohort Study (SCCS), a cohort of 86,000 persons accrued from community health clinics in the Southeast, focusing on the 48% who also had administrative data from Medicare linkage. Included subjects were diagnosed with incident hematuria in the primary care setting at age > 40, without pre-existing diagnoses that cause hematuria. Evaluation was considered complete if both abdomino-pelvic imaging and cystoscopy were performed within 180 days of hematuria diagnosis. Exposures of interest were race, gender, and risk factors for bladder cancer (age, smoking history and high-risk occupation). Multivariable models with interaction terms were fit to identify differences in evaluation among race/gender groups (RGG) and to determine whether risk factors predicted completeness of evaluation within each RGG. RESULTS: Among 1412 patients (60% AA; 64% female; median age 59), imaging was performed in 41-47% of cases, cystoscopy in 18-25%, and evaluation was complete in 15-23%, depending on RGG. On multivariable analysis, referral to urology was influenced by the number of risk factors in men (OR 1.66 [1.08, 2.55] p¼0.02), but not women (OR 1.18 [0.86, 1.61] p¼0.31) (figure). Use of imaging and cystoscopy were unrelated to number of risk factors in all RGGs. Complete evaluation was significantly lower in AA patients compared to whites (OR 0.65 [0.48, 0.89] p¼0.007), due to lower use of imaging (OR 0.74 [0.58, 0.94] p¼0.01) and cystoscopy (OR 0.66 [0.49, 0.89] p¼0.01). Gender differences in these outcomes were not significant. CONCLUSIONS: About 20% of patients in each RGG underwent complete evaluation. Number of risk factors predicted referral to urology among men, but was otherwise a poor predictor of evaluation. The likelihood of complete evaluation and each component thereof was lower in AA patients compared to whites; gender differences were smaller and nonsignificant. Increasing use of timely and complete evaluation for hematuria may reduce racial variation in bladder cancer stage at diagnosis.
e485
Source of Funding: NCI 1R03CA173807
PD23-12 HEMATURIA PRACTICE PATTERNS IN THE PRIMARY CARE SETTING Lisa Parrillo*, Justin Ziemba, Matthew Sterling, Alida Gertz, Phillip Mucksavage, Thomas Guzzo, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Hematuria is common and therefore the initial patient contact is often with their primary care or an emergency medicine provider. Understanding the practice patterns for the diagnosis and management of hematuria will allow for improved care delivery for patients. METHODS: A 22-question electronic survey was distributed to all 574 attending, fellow, resident, and advanced practice providers in the Internal Medicine, Family Medicine and Emergency Medicine Departments of a large academic health system. The survey assessed current practice patterns of diagnostic imaging, laboratory evaluation, and care coordination for gross and microscopic hematuria. RESULTS: A total of 137 (24%) providers completed the survey. Only 13% (18/135) of respondents were aware of the American Urological Association (AUA) guidelines on asymptomatic microscopic hematuria and only 30% (26/137) appropriately defined microscopic hematuria as a single urinalysis with 3 or more red blood cells per high-power field. A total of 35% of respondents would send a cytology: 15% (20/136) for all patients with hematuria, 12% (16/136) only for those with microscopic hematuria, and 8% (11/136) only for those with gross hematuria. 28% (39/137) of providers send urine cultures on patients with microscopic hematuria and 43% (58/ 136) on those with gross hematuria regardless of urinalysis or symptoms. Consultation with urology would be recommended by 45%, 10%, and 38% (62/137, 14/137, and 52/137) of respondents in all cases of hematuria, only microscopic hematuria, and only gross hematuria, respectively. 93% (127/ 137) felt that a clinical care pathway for the evaluation and management of hematuria would be valuable in their practice. CONCLUSIONS: Primary care providers are unaware of the AUA guidelines on asymptomatic microscopic hematuria. Furthermore, there is variability regarding the appropriate diagnostic imaging, laboratory evaluation, and referral amongst front-line providers. Development of clinical care pathways are desired and may improve adherence to already established evidence based guidelines. Source of Funding: none