Introduction: We utilized an eConsult program to assess the appropriateness and completeness of hematuria evaluation among one of the largest Medicaid networks in California, the Inland Empire Health Plan.
Methods: We retrospectively reviewed all hematuria consults from May 2018 to August 2020. Patient demographic and clinical data were extracted from the electronic health record and dialogues between primary care provider and specialist including laboratory results and imaging. We calculated the proportions of imaging types and the outcome of the eConsults among patients. χ2 and Fisher's exact tests were used for statistical analysis.
Results: A total of 106 hematuria eConsults were submitted. Primary care provider evaluation for risk factors rates were low: 37% gross hematuria, 29% voiding symptoms/dysuria, 49% other urothelial risk factors or benign etiology, and 63% smoking. Only 50% of all referrals were deemed appropriate based on a history of gross hematuria or ≥3 red blood cells/high-power field on urinalysis without evidence of infection or contamination. Thirty-one percent of patients received a renal ultrasound, 2.8% received CT urography, 5.7% received other cross-sectional imaging, and 64% received no imaging. By the conclusion of the eConsult only 54% of patients were referred for a face-to-face visit.
Conclusions: The use of eConsults allows for urological access in the safety-net population and presents a means to assess the urological needs in the community. Our findings suggest eConsults represent an opportunity to reduce the morbidity and mortality associated with hematuria among safety-net patients who are otherwise less likely to receive a proper evaluation.
Keywords: Medicaid; health services; hematuria; remote consultation; urologic neoplasms.