PD14-09 IDENTIFYING PATIENTS WITH MICROHEMATURIA AT RISK FOR A MISSED OR DELAYED DIAGNOSIS: WHO IS NOT BEING EVALUATED IN A TIMELY FASHION?

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures I1 Apr 2017PD14-09 IDENTIFYING PATIENTS WITH MICROHEMATURIA AT RISK FOR A MISSED OR DELAYED DIAGNOSIS: WHO IS NOT BEING EVALUATED IN A TIMELY FASHION? Richard Matulewicz, Jason Cohen, John Oliver DeLancey, and Joshua Meeks Richard MatulewiczRichard Matulewicz More articles by this author , Jason CohenJason Cohen More articles by this author , John Oliver DeLanceyJohn Oliver DeLancey More articles by this author , and Joshua MeeksJoshua Meeks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.710AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many patients with microhematuria (MH) do not complete the recommended evaluation: cystoscopy and genitourinary imaging. These patients are therefore at risk of a missed or delayed diagnosis. We sought to determine factors associated with a lower likelihood of completing a MH evaluation in a large health system as a step toward targeted quality improvement efforts. METHODS Patients 35 and older with a new diagnosis of MH (>3 RBC/hpf) in the absence of a benign cause were included. Data was source from our multi-center enterprise data warehouse during the years 2012-2015. Demographic and urinalysis (UA) data as well as details about the timing and completion of cystoscopy and appropriate imaging were collected. Regression modeling was used to determine factors associated with completing the MH evaluation within 1 year. RESULTS In total, 7,888 patients were included: 1,191 (15.1%) had a partial evaluation and 470 (6.0%) underwent a complete evaluation. Median days to complete evaluation was 77 [IQR 35-235]. Of those who had a partial evaluation, 37.1% had a cystoscopy and 62.9% had an imaging study. Younger patients, male patients, those with more severe MH on index UA, and those with a positive follow up UA all had higher unadjusted rates of evaluation. After adjusting for all covariates, male sex (OR 1.27, 95% CI 1.01-1.58), increasing MH severity on index UA (more RBC/hpf), and positive follow up UA (OR 3.21, 95% CI 2.49-5.14) but not age were significantly associated with receiving a complete evaluation within 1 year (Table 1). Of patients who had a documented complete evaluation 5.7% (n=27), 2.3% (n=11), and 14.3% (n=67) were diagnosed with bladder cancer, kidney cancer, and urolithiasis, respectively. CONCLUSIONS Few patients complete a timely evaluation for their MH. Hematuria severity and male sex are significantly associated with a higher likelihood of receiving a complete MH evaluation. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e280 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Richard Matulewicz More articles by this author Jason Cohen More articles by this author John Oliver DeLancey More articles by this author Joshua Meeks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...