Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer

Area of Science:

• Urology
• Oncology
• Health Informatics

Background:

• Timely diagnostic evaluation of hematuria is essential for early bladder cancer detection.
• Delays in diagnosis can negatively impact patient outcomes.

Purpose of the Study:

• To assess the effectiveness of electronic trigger algorithms in identifying delayed follow-up for patients with hematuria.
• To improve the diagnostic pathway for potential bladder cancer cases.

Main Methods:

• A computerized trigger was developed to flag delayed follow-up for high-grade hematuria (>50 RBCs/HPF) in a VA national data repository.
• The trigger excluded cases with terminal illness or documented follow-up actions like cystoscopy.
• Manual chart review of triggered and non-triggered records was performed to validate trigger performance.

Main Results:

• The trigger identified 5,857 patients with high-grade hematuria out of 310,331 patients, with 495 experiencing delays.
• On manual review, the trigger demonstrated a positive predictive value of 58% and a negative predictive value of 97%.

Conclusions:

• Electronic triggers are a promising tool for detecting delays in the care of patients with high-grade hematuria.
• Further clinical evaluation of these triggers is warranted to reduce delays in bladder cancer diagnosis.