Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer

Abstract

Triggers offer a promising method to detect delays in care of patients with high-grade hematuria and warrant further evaluation in clinical practice as a means to reduce delays in bladder cancer diagnosis.

Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review

“…Definitions of timely evaluation, referral and diagnosis, were described in 12 studies. For time to first evaluation including cystoscopy, upper urinary tract imaging or urine cytology, Garg et al used a threshold of 30 days,32 while two studies examined proportions of patients undergoing these tests within 6033 and 90 days 24. The remaining studies used 180 days as time cut-offs for which they considered evaluation should be carried out,22 28 34–36 although one also looked at completion within 365 years, and beyond 28.…”

“…Most studies reported the frequency of appropriate or guideline-concordant diagnostic tests and referrals performed during diagnostic evaluation (online supplementary appendix 2). Studies examining the frequency of non-evaluation of haematuria reported this to be 47%–81% within 60 days of initial symptom presentation,24 33 reducing to 36%–65% in studies by 180 days 22 34–36…”

“…Eleven studies reported the percentages of investigations and referrals performed in patients with haematuria,18 21 22 24 25 28 33–36 38 seven of which also specified time-frames during which these evaluations should be completed22 24 28 33–36 (online supplementary appendix 2). Five studies reported that only 5%–25% of these patients received both imaging and cystoscopy (commonly defined as ‘complete evaluation’ by the studies) by 6 months of their first presentation with haematuria25 28 34–36 and case series of 100 patients in a single institution reported this percentage to be 64% in their cohort 22…”

“…Ten of the 20 studies which extracted symptom information used coded information from routine or claims data,21 25 28 29 31 34 35 37–39 5 used self-reported symptoms from questionnaire and audit data,14–16 19 40 6 studies performed direct record review22 24 25 30 33 41 and 1 used coded information and record review 17…”

“…Other factors that were found to impact on the quality of the diagnostic process were described by studies using direct record review. These include patient factors such as not attending, cancelling or declining to attend follow-up appointments,33 delays in PCPs reviewing results, lack of receipt of referral,17 and scheduling and coordination delay of follow-up test or appointment,24 33 although the detailed effects of these factors on the quality of the diagnostic process were not reported.…”