MP23-16 HEMATURIA IN PRACTICE: LEVERAGING TELEMEDICINE TO EVALUATE 2020 AUA GUIDELINE FEASIBILITY IN THE SAFETY NET

Abstract

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making III (MP23)1 Sep 2021MP23-16 HEMATURIA IN PRACTICE: LEVERAGING TELEMEDICINE TO EVALUATE 2020 AUA GUIDELINE FEASIBILITY IN THE SAFETY NET Desiree Sanchez, Josiah Low, Alvin Kwong, Waheed Baqai, Sajid Ahmed, and Stanley Frencher Desiree SanchezDesiree Sanchez More articles by this author , Josiah LowJosiah Low More articles by this author , Alvin KwongAlvin Kwong More articles by this author , Waheed BaqaiWaheed Baqai More articles by this author , Sajid AhmedSajid Ahmed More articles by this author , and Stanley FrencherStanley Frencher More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002014.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hematuria can portend urologic malignancy but often does not receive complete evaluation, particularly in underserved settings. Safety net populations face resource limitations that may impede evaluation. Telemedicine services like electronic consultation (eConsult) increase urologic access by enabling asynchronous web-based consults and patient co-management between primary care providers and urologists. Using eConsult data, we evaluated patterns of hematuria and assessed feasibility of the new 2020 AUA microhematuria guidelines in California’s largest community-based Medicaid network, the Inland Empire Health Plan (IEHP). METHODS: We performed a retrospective chart review of all IEHP hematuria eConsults. Rates of documented imaging types (ultrasound (US), CT urogram (CTU), other cross sectional imaging) were calculated. Those with sufficient data capture were assigned a risk level per the new 2020 guidelines. Feasibility of guideline-based risk stratified management pathway was assessed according to differences in US and CTU received. Chi-square and Wilcoxon rank-sum tests were used to compare categorical and continuous variables respectively. RESULTS: There were 106 hematuria eConsults from 5/2018-8/2020. See table for demographics. Thirty (28%) patients had a documented US, 3 (3%) had both US and CTU, and 61 (58%) had neither; the difference was significant (p=0.009). Twelve (11%) had other cross sectional imaging. More low/intermediate-risk patients received renal US and CTU than high risk patients, 55.6% and 11.1% versus 26.7% and 3.3%, respectively; these differences were not statistically significant. Whether imaging was obtained and documented did not differ between physician versus midlevel, p=0.422. CONCLUSIONS: An eConsult system reveals that past AUA guidelines dictating universal CTU rarely translated to real life imaging in a diverse community Medicaid setting, whereas the risk stratification and associated imaging (US or CTU) adopted by the new 2020 guidelines more realistically aligns with imaging availability in this population. The large gap between those high risk patients without indicated CTU and those who actually receive it represents a key opportunity for reducing morbidity and mortality for safety net patients. Source of Funding: H&H Lee Surgical Research Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e408-e408 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Desiree Sanchez More articles by this author Josiah Low More articles by this author Alvin Kwong More articles by this author Waheed Baqai More articles by this author Sajid Ahmed More articles by this author Stanley Frencher More articles by this author Expand All Advertisement Loading ...