664 Background: First-line (1L) novel combination regimens have transformed outcomes for pts with locally advanced or metastatic urothelial carcinoma (LA/mUC). Community-based healthcare professionals (HCPs) face unique challenges with evolving guidelines and toxicity management. This initiative sought to address these gaps by equipping clinicians with evidence-based tools and strategies to improve care and outcomes. Methods: In Oct–Nov 2024, 31 HCPs from urban community clinics serving underserved populations were surveyed and chart audits were conducted (n = 150; 12% Stage 4, with treatment initiation after Dec 2023) to assess practice patterns and gaps in treatment. In live audit-feedback (AF) sessions, HCPs reviewed findings and developed action plans. Following implementation of action plans, including integration of a bladder cancer management pocket guide, HCPs participated in a PDSA workshop with an expert to review progress and refine processes. Follow-up surveys and chart audits evaluated practice change 6 months post-intervention. Results: Key barriers to evidence-based integration of 1L combination therapies included formulary restrictions (45%), limited evidence or guideline support (42%), and access/insurance barriers (39%). Few HCPs reported performing biomarker testing in every pt (3%). In choosing 1L systemic therapy, HCPs prioritized response rates (45%), pt medical factors (36%), toxicity (32%), and regimen familiarity (32%). Although 52% estimated most of their pts received enfortumab vedotin/pembrolizumab (E/P), chart audits showed only 32% of eligible pts initiated E/P, while 68% received single-agent (SA) immunotherapy (IO). Reasons for non-use included pt preference (58%), toxicity concerns (48%), and pt medical factors (36%), most commonly autoimmune disease (58%) or uncontrolled diabetes (23%). Chart audits revealed adverse events (AE) (52%) was the top reason for 1L treatment discontinuation. Following action plan implementation, HCPs reported making updates to clinical pathways, improvements in biomarker testing, and AE management through pt education and use of the pocket guide. System-level changes included standardized testing, enhanced workflows, and chart audit tracking to sustain practice improvement. Additional follow-up data will be presented. Conclusions: This QI initiative identified gaps in evidence-based integration of 1L combination therapy and biomarker testing for LA/mUC in community settings. Through AF, action planning, and use of a pocket guide, providers improved evidence-based treatment, biomarker testing, shared decision-making, and AE management. These findings highlight the need to strengthen workflows, standardize testing, and support under-resourced clinics, providing a scalable framework to improve LA/mUC care across diverse practice settings.
Petrylak et al. (Sun,) studied this question.