Low‐Value Prostate Cancer Screening Among Older Men Within the Veterans Health Administration - American Geriatric Society

BACKGROUND/OBJECTIVES

Prostate‐specific antigen (PSA) screening can be of low value in older adults. Our objective was to quantify the prevalence and variation of low‐value PSA screening across the Veterans Health Administration (VA), which has instituted programs to reduce low‐value care.

DESIGN

Retrospective cohort.

SETTING

VA administrative data, 2014 to 2015.

PARTICIPANTS

National random sample (N = 214 480) of male veterans, aged 75 years or older.

MEASUREMENTS

We defined PSA screening in men aged 75 years or older without a history of prostate cancer as low value, per established definitions in Medicare. We calculated screening rates overall and by VA Medical Center (VAMC), adjusting for patient and VAMC‐level factors. We characterized variation across VAMCs using the adjusted median odds ratio (OR) and compared the adjusted OR of screening between VAMCs in different deciles of low‐value screening rates. In separate sensitivity analyses, we assessed screening in veterans at greatest risk of 1‐year mortality and among veterans after excluding those who underwent prostatectomy, had a prior PSA elevation, or had a clinical indication for testing.

RESULTS

Overall, 37 867 (17.7%) of veterans underwent low‐value PSA screening (VAMC range = 3.3%‐38.2%). The adjusted median OR was 1.88, meaning the median odds of screening would increase by 88% were a veteran to transfer his care to a VAMC with higher screening rates. Veterans at VAMCs in the top decile had an adjusted OR of 12.9 (95% confidence interval = 11.0‐15.2) compared to those veterans in the lowest decile. Among veterans with the greatest mortality risk (n = 23 377), 3496 (15.0%) underwent screening (VAMC range = 1.7%‐46.3%). After excluding veterans with a prior prostatectomy, PSA elevation, or a potential clinical indication, 31 556 (14.7%) underwent screening (VAMC range = 2.0%‐49.9%).

CONCLUSIONS

In a national cohort of older veterans, more than one in six received low‐value PSA screening, with greater than 10‐fold variation across VAMCs and high rates of screening among those with the greatest mortality risk.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2NCPr8h
via IFTTT