Methods: We designed an EHR-integrated intervention within the Epic EHR (Epic Systems) based on the AUA NMIBC pathways. Our multidisciplinary group created 4 pathways for the clinical management of NMIBC: Evaluation and Staging, Low and Intermediate Risk, High and Very High Risk, and Persistent or Recurrent Disease. Adoption was encouraged through a communication strategy including newsletters, site visits, and continuing medical education-accredited meetings.
Results: From October 2021 to May 2024, the Care Pathway was used 412 times across various encounter types, including procedural, office-based, and telemedicine visits, involving 253 patients (mean age: 70 years). Self-pay (84; 33.2%) and Medicare (66; 26.1%) were the most common payer type. Sixty-eight providers used the pathway, most commonly by medical doctors (38; 55.9%) and registered nurses (14; 20.6%). The pathway was used primarily in the urology specialty (28; 41.8%), but utilization also occurred in the primary care setting. The initial staging and treatment of low and intermediate risk pathway was the most used Care Pathway (150; 36.4%).
Conclusions: The EHR-integrated intervention was designed to improve adherence to AUA NMIBC guidelines across diverse clinical scenarios and was adopted by providers with varying expertise. This pathway could improve standardized care delivery and reduce practice variability in NMIBC management. Further evaluation of its long-term impact on clinical outcomes is warranted.
Shayan Smani,1 Soum D Lokeshwar,1 Michael Jalfon,1 Dylan Heckscher,1 Benjamin H Press,1 Daniel Heacock,2 Michael S Leapman,1 Patrick Kenney,1 Fady Ghali1
- Department of Urology, Yale School of Medicine, New Haven, Connecticut.
- Yale-New Haven Hospital, New Haven, Connecticut.