PDF(Pubmed)
Abstract：
To determine if accurate documentation of bladder cancer risk was associated with a clinician surveillance recommendation that is concordant with AUA guidelines among patients with nonmuscle invasive bladder cancer (NMIBC).
We prospectively collected data from cystoscopy encounter notes from four Department of Veterans Affairs (VA) sites to ascertain whether they included accurate documentation of bladder cancer risk and a recommendation for a guideline-concordant surveillance interval. Accurate documentation was a clinician-recorded risk classification matching a gold standard assigned by the research team. Clinician recommendations were guideline-concordant if the clinician recorded a surveillance interval that was in line with the AUA guideline.
Among 296 encounters, 75 were for low-, 98 for intermediate-, and 123 for high-risk NMIBC. 52% of encounters had accurate documentation of NMIBC risk. Accurate documentation of risk was less common among encounters for low-risk bladder cancer (36% vs 52% for intermediate- and 62% for high-risk, P < .05). Guideline-concordant surveillance recommendations were also less common in patients with low-risk bladder cancer (67% vs 89% for intermediate- and 94% for high-risk, P < .05). Accurate documentation was associated with a 29% and 15% increase in guideline-concordant surveillance recommendations for low- and intermediate-risk disease, respectively (P < .05).
Accurate risk documentation was associated with more guideline-concordant surveillance recommendations among low- and intermediate-risk patients. Implementation strategies facilitating assessment and documentation of risk may be useful to reduce overuse of surveillance in this group and to prevent unnecessary cost, anxiety, and procedural harms.
We prospectively collected data from cystoscopy encounter notes from four Department of Veterans Affairs (VA) sites to ascertain whether they included accurate documentation of bladder cancer risk and a recommendation for a guideline-concordant surveillance interval. Accurate documentation was a clinician-recorded risk classification matching a gold standard assigned by the research team. Clinician recommendations were guideline-concordant if the clinician recorded a surveillance interval that was in line with the AUA guideline.
Among 296 encounters, 75 were for low-, 98 for intermediate-, and 123 for high-risk NMIBC. 52% of encounters had accurate documentation of NMIBC risk. Accurate documentation of risk was less common among encounters for low-risk bladder cancer (36% vs 52% for intermediate- and 62% for high-risk, P < .05). Guideline-concordant surveillance recommendations were also less common in patients with low-risk bladder cancer (67% vs 89% for intermediate- and 94% for high-risk, P < .05). Accurate documentation was associated with a 29% and 15% increase in guideline-concordant surveillance recommendations for low- and intermediate-risk disease, respectively (P < .05).
Accurate risk documentation was associated with more guideline-concordant surveillance recommendations among low- and intermediate-risk patients. Implementation strategies facilitating assessment and documentation of risk may be useful to reduce overuse of surveillance in this group and to prevent unnecessary cost, anxiety, and procedural harms.
摘要：
目的：在非肌层浸润性膀胱癌（NMIBC）患者中，确定膀胱癌风险的准确记录是否与符合AUA指南的临床医生监测建议相关。
方法：我们前瞻性地收集了来自4个退伍军人事务部(VA)中心的膀胱镜检查见习记录的数据，以确定这些数据是否包括膀胱癌风险的准确记录和指南一致监测间隔的建议。准确的文档是临床医生记录的风险分类与研究团队指定的黄金标准相匹配。如果临床医生记录的监测间隔符合AUA指南，则临床医生的建议与指南一致。
结果：在296次相遇中，75人是低的，98为中间人-，和123高风险NMIBC。52％的遭遇有NMIBC风险的准确记录。风险的准确记录在低风险膀胱癌的遭遇中并不常见（中间者为36％，高风险者为52％，为62％，p<0.05)。指南一致的监测建议在低风险膀胱癌患者中也不太常见(67%vs.89%的中危患者和94%的高危患者,p<0.05)。准确的记录与低风险和中风险疾病的指南一致监测建议增加了29%和15%。分别为(p<0.05)。
结论：在低风险和中危患者中，准确的风险记录与更多指南一致的监测建议相关。促进风险评估和记录的实施策略可能有助于减少该组中过度使用监视并防止不必要的成本，焦虑,和程序上的危害。
方法：我们前瞻性地收集了来自4个退伍军人事务部(VA)中心的膀胱镜检查见习记录的数据，以确定这些数据是否包括膀胱癌风险的准确记录和指南一致监测间隔的建议。准确的文档是临床医生记录的风险分类与研究团队指定的黄金标准相匹配。如果临床医生记录的监测间隔符合AUA指南，则临床医生的建议与指南一致。
结果：在296次相遇中，75人是低的，98为中间人-，和123高风险NMIBC。52％的遭遇有NMIBC风险的准确记录。风险的准确记录在低风险膀胱癌的遭遇中并不常见（中间者为36％，高风险者为52％，为62％，p<0.05)。指南一致的监测建议在低风险膀胱癌患者中也不太常见(67%vs.89%的中危患者和94%的高危患者,p<0.05)。准确的记录与低风险和中风险疾病的指南一致监测建议增加了29%和15%。分别为(p<0.05)。
结论：在低风险和中危患者中，准确的风险记录与更多指南一致的监测建议相关。促进风险评估和记录的实施策略可能有助于减少该组中过度使用监视并防止不必要的成本，焦虑,和程序上的危害。
