Development and Utilization of a Novel Electronic Health Record-Based Care Pathway for Nonmuscle-Invasive Bladder...

Area of Science:

• Urology
• Health Informatics
• Clinical Practice Guidelines

Background:

• Adherence to clinical practice guidelines for non-muscle-invasive bladder cancer (NMIBC) management is suboptimal.
• There is a need for interventions to improve guideline compliance in NMIBC care.

Purpose of the Study:

• To develop and implement an electronic health record (EHR)-integrated intervention to enhance adherence to NMIBC clinical guidelines.
• To create structured pathways for NMIBC management within an EHR system.

Main Methods:

• An EHR-integrated intervention was designed using the Epic EHR system, based on American Urological Association (AUA) NMIBC pathways.
• Four distinct pathways were developed: Evaluation and Staging, Low and Intermediate Risk, High and Very High Risk, and Persistent or Recurrent Disease.
• A communication strategy including newsletters, site visits, and CME-accredited meetings was employed to encourage adoption.

Main Results:

• The intervention, termed 'Care Pathway', was utilized 412 times between October 2021 and May 2024, involving 253 patients.
• Sixty-eight providers across various specialties, primarily urology, adopted the pathway.
• The 'Initial Staging and Treatment of Low and Intermediate Risk' pathway was the most frequently used (36.4%).

Conclusions:

• The EHR-integrated intervention demonstrated adoption by providers with diverse expertise, indicating its potential utility.
• This intervention may improve standardized care delivery and reduce practice variability in NMIBC management.
• Further research is necessary to evaluate the long-term impact of this pathway on clinical outcomes.