What is evaluation of hematuria by primary care physicians? Use of electronic medical records to assess practice patterns with intermediate follow-up

Variation in the Intensity of Hematuria Evaluation: A Target for Primary Care Quality Improvement

“…3 Current literature suggests that fewer than half of patients diagnosed with hematuriaare subsequently referred to a urologist for evaluation. 4–6 While urinary tract infection, benign prostatic hyperplasia, andurolithiasis represent common nonmalignant etiologies of hematuria 7 failure to adequately evaluate patients with hematuria risks delaying the diagnosis of potentially lethal malignancies such as bladder cancer, and is therefore a significant quality of care concern.…”

“…6, 8 The prevalence of microscopic hematuria in the adult population ranges from 2.4% to 31.1%, and up to 3.3% of these individuals will have an underlying urothelial malignancy. 9 Conversely, between 9% and 18% of patients with hematuria will have no underlying pathology, drawing into question the utility of ubiquitous hematuria evaluations.…”

Evaluation of Microscopic Hematuria: A Critical Review and Proposed Algorithm

“…Although the current AUA guidelines are too recent for a long-term analysis of compliance, several studies examining physician compliance with the 2001 AUA recommendations revealed low rates of testing and urology referrals, even for patients with clear risk factors for GU cancer. [79][80][81][82] Suggested explanations for low adherence include the possibility that the guideline recommends evaluations for an unnecessarily high proportion of the population. One author opined that "the lack of selectivity of the guidelines has reduced utilization.…”

“…One author opined that "the lack of selectivity of the guidelines has reduced utilization. 81 " As the latest AUA guideline recommends urologic evaluation for an even greater proportion of those with MH, further studies should be performed to document the effect on adherence.…”

Gender, Race, and Variation in the Evaluation of Microscopic Hematuria Among Medicare Beneficiaries

“…[2][3][4][5][6] The evaluation recommended by the American Urological Association for microscopic hematuria includes cystoscopy and upper tract imaging for those without an obvious benign etiology. 7,8 Population-based studies suggest that the minority of those with hematuria are evaluated (9-36 %), 9,10 a finding that persists even in those at high risk for malignancy. 11 The quality of a hematuria evaluation is determined by its completeness and timeliness.…”