title: What is evaluation of hematuria by primary care physicians? Use of electronic medical records to assess practice patterns with intermediate follow-up.
abstract: BACKGROUND
  To determine whether patients found to have hematuria by their primary care physicians are evaluated according to best practice policy.
  
  
  METHODS
  The University of Texas Southwestern Medical Center maintains institutional outpatient electronic medical records (EMR) that are used by all providers in all specialties. We conducted an Institutional Review Board approved observational study of patients found to have more than 5 red blood cells/high power field between March 2009 and February 2010.
  
  
  RESULTS
  There were 449 patients of whom the majority were female (82%), Caucasian (39%), with microscopic hematuria (MH) (85%). Almost 58% of patients were initially symptomatic with urinary symptoms or pain. Evaluation for the source of hematuria was limited and included imaging (35.6%), cystoscopy (9%, and cytology (7.3%). Only 36% of men and 8% of women were referred to a urologist. No abnormality was found in 32% and 51% of patients with gross hematuria and MH, respectively (P = 0.004). There were 4 bladder tumors and 1 renal mass detected. Male gender, ethnicity and gross (vs. microscopic) hematuria were associated with higher rate of urological referral. Advanced age, smoking, provider practice type, and the presence of urinary symptoms were not associated with an increase rate of urological referral. No additional cancers were diagnosed with 29-month follow-up.
  
  
  CONCLUSIONS
  While urinalysis remains a common diagnostic tool, most cases of both microscopic and gross hematuria are not fully evaluated according to guidelines. Use of cystoscopy, cytology, and upper tract imaging is limited. Further studies will be needed to determine the extent of the problem and impact on morbidity and survival.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Anna
authors.initials: A
authors.lastname: Buteau
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Casey A
authors.initials: CA
authors.lastname: Seideman
authors.affiliation: Department Urology, University of Texas Health Science Center of San Antonio, San Antonio, TX.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Gaurab
authors.initials: G
authors.lastname: Chakrabarti
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Gary
authors.initials: G
authors.lastname: Reed
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Deepa
authors.initials: D
authors.lastname: Bhat
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: yair.lotan@utsouthwestern.edu.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D044466:Asian People / Q000706:statistics & numerical data; D015331:Cohort Studies; D003558:Cystoscopy / Q000706:statistics & numerical data; D003581:Cytodiagnosis / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000175:diagnosis* / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016482:Urinalysis / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data