Medical Center Characteristics Associated with PSA Screening in Elderly Veterans with Limited Life Expectancy

Cynthia SO; Katharine A KIRBY; Kala MEHTA; Richard M HOFFMAN; Adam A POWELL; Stephen J FREEDLAND; Brenda SIROVICH; Elizabeth M YANO; Louise C WALTER

doi:10.1007/s11606-011-1945-9

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Medical Center Characteristics Associated with PSA Screening in Elderly Veterans with Limited Life Expectancy

Journal article

Open access

Peer reviewed

Medical Center Characteristics Associated with PSA Screening in Elderly Veterans with Limited Life Expectancy

Cynthia SO, Katharine A KIRBY, Kala MEHTA, Richard M HOFFMAN, Adam A POWELL, Stephen J FREEDLAND, Brenda SIROVICH, Elizabeth M YANO and Louise C WALTER

Journal of general internal medicine : JGIM, Vol.27(6), pp.653-660

2012

DOI: 10.1007/s11606-011-1945-9

PMCID: PMC3358397

PMID: 22180196

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Abstract

Background: Although guidelines recommend against prostate-specific antigen (PSA) screening in elderly men with limited life expectancy, screening is common. Objective: We sought to identify medical center characteristics associated with screening in this population. Design/participants: We conducted a prospective study of 622,262 screen-eligible men aged 70+ seen at 104 VA medical centers in 2003. Main measures: Primary outcome was the percentage of men at each center who received PSA screening in 2003, based on VA data and Medicare claims. Men were stratified into life expectancy groups ranging from favorable (age 70-79 with Charlson score = 0) to limited (age 85+ with Charlson score ≥1 or age 70+ with Charlson score ≥4). Medical center characteristics were obtained from the 1999-2000 VA Survey of Primary Care Practices and publicly available VA data sources. Key results: Among 123,223 (20%) men with limited life expectancy, 45% received PSA screening in 2003. Across 104 VAs, the PSA screening rate among men with limited life expectancy ranged from 25-79% (median 43%). Higher screening was associated with the following center characteristics: no academic affiliation (50% vs. 43%, adjusted RR = 1.14, 95% CI 1.04-1.25), a ratio of midlevel providers to physicians ≥3:4 (55% vs. 45%, adjusted RR = 1.20, 95% CI 1.09-1.32) and location in the South (49% vs. 39% in the West, adjusted RR = 1.25, 95% CI 1.12-1.40). Use of incentives and high scores on performance measures were not independently associated with screening. Within centers, the percentages of men screened with limited and favorable life expectancies were highly correlated (r = 0.90). Conclusions: Substantial practice variation exists for PSA screening in older men with limited life expectancy across VAs. The high center-specific correlation of screening among men with limited and favorable life expectancies indicates that PSA screening is poorly targeted according to life expectancy.

Public health. Hygiene-occupational medicine

Public health. Hygiene

Biological and medical sciences

General aspects

Medical sciences

Prevention and actions

Details

Title: Subtitle: Medical Center Characteristics Associated with PSA Screening in Elderly Veterans with Limited Life Expectancy
Creators: Cynthia SO - School of Medicine, University of California, San Francisco, CA, United States
Katharine A KIRBY - Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA, United States
Kala MEHTA - Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA, United States
Richard M HOFFMAN - New Mexico VA Health Care System, Albuquerque and Department of Medicine, University of New Mexico, Albuquerque, NM, United States
Adam A POWELL - Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System and Department of Medicine, University of Minnesota, Minneapolis, MN, United States
Stephen J FREEDLAND - Durham VA Medical Center and Duke Prostate Center, Duke University, Durham, NC, United States
Brenda SIROVICH - White River Junction VA, Windsor, VT, United States
Elizabeth M YANO - VA HSR&D Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health System and Department of Health Services, UCLA School of Public Health, Los Angeles, CA, United States
Louise C WALTER - Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA, United States
Resource Type: Journal article
Publication Details: Journal of general internal medicine : JGIM, Vol.27(6), pp.653-660
DOI: 10.1007/s11606-011-1945-9
PMID: 22180196
PMCID: PMC3358397
NLM abbreviation: J Gen Intern Med
ISSN: 0884-8734
eISSN: 1525-1497
Publisher: Springer
Language: English
Date published: 2012
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094521102771

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