Utilization and Timing of Cystoscopy for Hematuria Evaluation by Advanced Practice Providers and Urologists

Abstract

ObjectiveTo characterize differences between urologists and advanced practice providers (APPs) in utilization of cystoscopy for hematuria. MethodsWe identified patients initially evaluated for hematuria by a urologist or urology APP between 2015 and 2020 in the MarketScan® Research Databases. We determined whether they received a cystoscopy within six months of their urology visit and the number of days until cystoscopy. We used multivariable regression to analyze the association between these outcomes and whether the urology clinician was an advanced practice registered nurse (APRN), physician assistant (PA), or urologist. ResultsWe identified 34,470 patients with microscopic hematuria and 17,328 patients with gross hematuria. Patients evaluated by urologists more often received a same-day cystoscopy than those evaluated by APPs (13% vs 5.8%). The odds that patients evaluated for microscopic and gross hematuria received a cystoscopy were 46.2% and 26.2% lower, respectively, if they were evaluated by an APRN versus a urologist. Patients seeing an APRN for microscopic and gross hematuria also waited approximately 7 and 14 days longer for their cystoscopy, respectively. No differences were observed for patients evaluated by PAs versus urologists. ConclusionPatients evaluated for hematuria by an APRN were less likely to receive a cystoscopy and had a longer wait until the procedure compared to those evaluated by a urologist; however, no differences were observed between PAs and urologists. Better understanding APP integration into urology clinics is warranted.