Defining Diagnostic Excellence

Diagnostic excellence, as outlined by Yang et al¹ in the Journal of the American Medical Association series, is an optimal process to achieve accurate and precise explanations for patient conditions. This process is timely, cost-effective, patient centered, and understandable, with the ultimate goal of guiding superior treatment decisions. It integrates quality dimensions such as safety, efficiency, equity, and effectiveness, as established by the National Academy of Medicine. Diagnostic excellence is not merely about accuracy but also about improving clinical outcomes and reducing disparities.

Diagnostic Excellence in Urology: A Focus on Prostate Cancer

Urology is uniquely positioned to benefit from diagnostic excellence principles due to its extensive interface between primary care and specialty care. The AUA has embraced these principles by developing evidence-based guidelines that emphasize individualized, risk-stratified evaluation. A salient example is the 2023 update to the AUA’s guideline on prostate cancer early detection.² This guideline prioritizes equity by addressing the significant diagnostic and outcome disparities faced by Black men, who are disproportionately affected by aggressive prostate cancer.

Black men experience higher rates of prostate cancer diagnosis and mortality compared with White men, driven by biological, socioeconomic, and systemic health care factors. Despite comprising 13% of the US population, Black men account for 30% of prostate cancer deaths but represent less than 1% of participants in prostate cancer screening trials.³ The absence of culturally tailored diagnostic tools exacerbates these inequities, underscoring the urgent need for targeted resources to enhance diagnostic accuracy and timeliness.

AUA’s Council of Medical Specialty Societies–Funded Initiative: Promoting Diagnostic Excellence in Prostate Cancer Care

The AUA received funding from the Gordon and Betty Moore Foundation and The John A. Hartford Foundation through a grant program administered by the Council of Medical Specialty Societies to develop and disseminate resources that promote diagnostic excellence in urology, with a particular focus on Black men at elevated risk of prostate cancer. The initiative’s goals included:

1. Educational Outreach to Urologists: An educational review article and podcast highlight diagnostic excellence principles within urology, using PSA screening in high-risk populations as a case study.⁴ By publishing this in The Journal of Urology^® and making it accessible through multiple channels, the AUA seeks to elevate awareness and engagement.
2. Clinical Decision Support Tools: The AUA developed a flowchart/algorithm based on its 2023 guideline to guide primary care providers (PCPs) in initiating prostate cancer screening conversations, particularly with Black patients. These resources aim to improve the implementation of risk-stratified screening.
3. Infographic to Address Disparities: The infographic illustrates disparities in prostate cancer outcomes and the benefits of risk-adjusted PSA screening. This resource serves as an educational tool for both urologists and PCPs.
4. Patient-Facing Materials: Culturally sensitive resources, such as dialogue tools, were developed to empower Black men to make informed decisions about prostate cancer screening and engage in meaningful conversations with their health care providers.

The resources developed through grant funding can be found at the AUA's Diagnostic Excellence page or by scanning the QR code. 

Addressing Health Equity Through Diagnostic Excellence

Health equity is central to diagnostic excellence. By tailoring diagnostic guidelines and tools to high-risk populations, the AUA seeks to mitigate disparities and improve outcomes. This approach is particularly crucial for prostate cancer, where early and accurate diagnosis can significantly influence survival rates. For example, the updated AUA guideline recommends initiating screening for Black men and other high-risk groups at ages 40 to 45, earlier than standard recommendations. Evidence suggests that PCPs equipped with culturally appropriate resources are better positioned to identify and address the unique needs of these populations.

Measuring Success

The project’s success continues to be evaluated through widespread dissemination and engagement metrics, including:

• Publication and access metrics for educational materials.
• Utilization rates of clinical decision tools and patient resources.
• Collaborations with organizations addressing prostate cancer disparities.

The overarching goal is to reach over 24,000 AUA members and broader primary care networks, with the potential to influence tens of thousands of patient interactions annually.

Conclusion

The AUA’s recently funded Council of Medical Specialty Societies grant demonstrates a comprehensive approach to integrating diagnostic excellence into urology care, and should be viewed as a template by which to apply diagnostic excellence principles to other urologic conditions. Through the creation of educational materials, clinical decision tools, and culturally sensitive patient resources, this project specifically addresses the disparities in prostate cancer diagnosis and outcomes experienced by Black men. By leveraging evidence-based guidelines and collaborative efforts, the AUA seeks to empower both health care providers and patients, ensuring timely and accurate diagnoses while advancing health equity. This initiative not only highlights the application of diagnostic excellence principles but also serves as an actionable framework for other medical specialties aiming to achieve precision and equity in care delivery.