Outcomes of Hematuria Evaluation by Advanced Practice Providers and Urologists

OBJECTIVE To examine the quality and costs of care for patients evaluated for hematuria by urologic advanced practice providers (APPs) and urologists. The roles of APPs in urology are growing, but their clinical and financial outcomes compared to urologists are not well understood. METHODS We conducted a retrospective cohort study of commercially insured patients using data from 2014 to 2020. We included adult beneficiaries with a diagnosis code for hematuria and an initial outpatient evaluation and management visit with a urologic APP or urologist. We assessed receipt of cystoscopy procedure, imaging study, bladder biopsy procedure, and bladder cancer diagnosis within 6 months of the initial visit. Secondary outcomes included the time until each of these outcomes occurred and the out-of-pocket spending and total payments. RESULTS We identified 59,923 patients who were initially evaluated for hematuria. Visits with urologic nurse practitioners rather than urologists were associated with significantly lower odds of receiving cystoscopy procedures (odds ratio [OR] 0.93, 95% confidence interval [95% CI] 0.540.72, P <.001), imaging studies (OR 0.79, 95% CI 0.69-0.91, P <.001), and bladder biopsy procedures (OR 0.61, 95% CI 0.41-0.92, P =.02). Visits with urologic physician assistants were associated with 11% greater out-of-pocket payments (incident risk ratio 1.11, CI 1.01-1.22, P =.02) and 14% greater total payments (incident risk ratio 1.14, CI 1.04-1.25, P =.004). CONCLUSION There are clinical and financial differences in hematuria care delivered by urologic APPs and urologists. The incorporation of APPs into urologic care warrants further study, and specialtyspecific training for APPs should be considered. UROLOGY 178: 67-75, 2023. (c) 2023 Elsevier Inc. All rights reserved.