Toward the Deimplementation of Computed Tomography Urogram for Patients With Low- to Intermediate-risk Microscopic Hematuria: A Mixed-method Study of Factors Influencing Continued Use

Abstract

Introduction: Citing high costs, limited diagnostic benefit, and ionizing radiationeassociated risk from CT urogram, in 2020 the AUA revised its guidelines from recommending CT urogram for all patients with microscopic hematuria to a deintensified risk-stratified approach, including the deimplementation of low-value CT urogram (ie, not recommending CT urogram for patients with lowto intermediate-risk microscopic hematuria). Adherence to revised guidelines and reasons for continued low-value CT urogram are unknown.

Physician perspectives on clinician-to-clinician telemedical consultation for gynecologic cancers: A qualitative study

“…store-and-forward) applications of telemedicine. Interviews were conducted by CW, a qualitative methods expert with experience using the combined CFIR-TDF framework in implementation research ( Birken et al, 2023 ). Interviews were conducted via videoconference, recorded, and transcribed verbatim.…”

Editorial Comment

“…In this mixedmethods explanatory research study, Birken et al adeptly combine electronic health record (EHR) data analysis and provider perspectives from a tertiary medical center, providing a comprehensive understanding of factors that contribute to the persistence of low-value CT urogram (CTU) use. 1 While numerous authors (including from our group) have examined care variations to identify targets to lessening low-value care, 2,3 Birken and colleagues should be congratulated for advancing the science of deimplementation with this innovative mixed-methods approach.…”