An evidence-based microscopic hematuria care pathway optimizes decision-making among providers.

Autor: Kent LM; University of Texas at Austin Dell Medical School, 1301 W. 38th St. Suite 705, TX, 78705, Austin, USA. laura.kent1@ascension.org., High RA; University of Texas at Austin Dell Medical School, 1301 W. 38th St. Suite 705, TX, 78705, Austin, USA., Papermaster AE; University of Texas at Austin Dell Medical School, 1301 W. 38th St. Suite 705, TX, 78705, Austin, USA., Caldwell LE; University of Texas at Austin Dell Medical School, 1301 W. 38th St. Suite 705, TX, 78705, Austin, USA., Rieger MM; University of Texas at Austin Dell Medical School, 1301 W. 38th St. Suite 705, TX, 78705, Austin, USA., White AB; University of Texas at Austin Dell Medical School, 1301 W. 38th St. Suite 705, TX, 78705, Austin, USA., Rogers RG; Albany Medical Center, Albany, NY, USA.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2023 Jul; Vol. 34 (7), pp. 1447-1451. Date of Electronic Publication: 2022 Oct 15.
DOI: 10.1007/s00192-022-05382-4
Abstrakt: Introduction and Hypothesis: Microscopic hematuria (MH) has many etiologies in women and requires specific gynecologic evaluation. We created a standardized MH pathway to serve as an evidence-based decision aid for providers in our practice.
Methods: Using a modified Delphi process, a multidisciplinary team reviewed existing guidelines for MH diagnosis and treatment to reach consensus on care pathway components.
Results: Entry into the care pathway by an advanced practice provider is determined by the finding of ≥3 red blood cells per high-power field (RBC/HPF) on microscopic urinalysis. Initial evaluation includes history and physical exam. If there are signs of a gynecologic cause of MH, the conditions are treated and repeat urinalysis is performed in 6 months. If repeat urinalysis shows persistent MH or there are no other apparent causes for MH, we proceed with risk stratification. Through shared decision-making, low-risk patients may undergo repeat urinalysis in 6 months or cystoscopy with urinary tract ultrasound. For intermediate-risk patients, cystoscopy and urinary tract ultrasound are recommended. For high-risk patients, cystoscopy and axial upper urinary tract imaging are recommended. If evaluation is positive, urology referral is provided. If evaluation is negative, low-risk patients are released from care, but intermediate-risk or high-risk patients undergo repeat urinalysis in 12 months. If repeat urinalysis is positive, shared decision-making is used to determine a plan.
Conclusions: We developed an MH care pathway to standardize care of women with MH across a multidisciplinary group. This pathway serves as a component of value-based care and supports evidence-based care by providers.
(© 2022. The International Urogynecological Association.)
Databáze: MEDLINE
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