Is Anyone Listening? Variation in PSA Screening among Providers for Men 75+ before and after United States Preventive Services Task Force Recommendations against It: A Retrospective Cohort Study

Goodwin, James S.; Jaramillo, Elizabeth; Yang, Liu; Tan, Alai

doi:10.1371/journal.pone.0107352

Cited by 14 publications

(9 citation statements)

References 42 publications

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“…Two recent reviews indicated that screening rates have declined, but these reviews synthesized heterogeneous data including self‐reports (which have been shown to be biased), small areas, and different time periods. Two studies that used objective screening measures spanning 2008 to 2012 showed the same pattern as ours, whereas others using shorter time periods or limited areas showed only declining rates . We found no prior studies of change in PSA screening rates in response to guidelines according to race, although two studies found no differential effect of race when examining referral or stage of disease .…”

Section: Discussionsupporting

confidence: 72%

“…Two studies that used objective screening measures spanning 2008 to 2012 showed the same pattern as ours, 43,44 whereas others using shorter time periods or limited areas showed only declining rates. [45][46][47][48][49][50] We found no prior studies of change in PSA screening rates in response to guidelines according to race, although two studies found no differential effect of race when examining referral or stage of disease. 51,52 Our study has the advantage over these prior studies of using consistent measures of PSA testing well before and after evidence change, with a large enough sample to examine heterogeneity of change across subgroups of men and across areas.…”

Section: Discussionmentioning

confidence: 72%

“…53 Primary care providers, many of whom agree with the guidelines 54 , are key players in changing screening practice because of their role in cancer prevention and frequent contact, 55 but the evidence suggests that patients are informed infrequently and that providers have not changed their practice much. 43,46,55 Change strategies that rely on encouraging shared decision-making without providing systematic support for the time those patient-provider interactions require are unlikely to lead to wholesale change in use of low-value care. Moreover, lack of feedback about a provider's current performance precludes the ability to evaluate and change one's practice.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Exnovation of Low Value Care: A Decade of Prostate‐Specific Antigen Screening Practices

Bynum

Passow

Carmichael

et al. 2018

J American Geriatrics Society

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Background Reducing use of low-value services is a priority for improving quality and lowering cost of care. The release of trial evidence in 2009 showing low value for prostate-specific antigen (PSA) screening in asymptomatic men and the convergence of guidelines offers an opportunity to study how clinical practice evolves with mounting consensus about the low value of a service. Objective Examine PSA screening practice change across subgroups of men defined in guidelines and across regions, identifying factors associated with change in screening practices. Design Observational study using serial cross-sections, 2003 to 2013 Setting National fee-for-service Medicare Participants Men age 68 and older eligible for prostate cancer screening Measurements Outcomes are national PSA screening practices among men age 68 and older from 2003–2013 and change in regional screening rates among men age 75 and older. Results The PSA screening rate among men age 68 and over was 17.2% in 2003, 22.3% in 2008, and 18.6% in 2013 (p<.001 for all differences); rates ended slightly lower than rates in 2003 only among men 80 and older. Racial disparities in screening became less pronounced over this period. Among men 75 and older, change in regional screening rates varied widely, with absolute rates growing by 15 per 100 enrollees in some areas and declining by the same amount in others. Areas with high social capital, a measure associated with diffusion of new ideas, were more likely to decline while malpractice intensity and managed care penetration had no impact. Conclusions Studying Medicare enrollees over time, we found little reduction in PSA screening and even increases by race and in some regions. The heterogeneous changes across regions suggest consistent reduction in the use of low-value care may require change strategies that go beyond evidence and guidelines to include monitoring and feedback on performance.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Exnovation of Low Value Care: A Decade of Prostate‐Specific Antigen Screening Practices

Bynum

Passow

Carmichael

et al. 2018

J American Geriatrics Society

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“…We defined incident cancer as a new diagnosis (none in prior year) of breast or prostate cancer plus evidence of treatment (surgery, radiotherapy, chemotherapy, hormone therapy) as previously defined. 22,23 This excluded 14,715 women with incident breast cancer and 15,245 men with incident prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

Receipt of Cancer Screening Is a Predictor of Life Expectancy

Goodwin

Sheffield

et al. 2016

J GEN INTERN MED

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“…The United States (U.S.) Preventive Services Task Force [ 1 ], the American Cancer Society [ 2 ], the American College of Physicians [ 3 ], and the American Urological Association [ 4 ] recommend against the use of the prostate-specific antigen (PSA) test to detect prostate cancer in men aged 75 years and older or those with a life expectancy of less than 10 to 15 years, because the risk of harms outweighs potential benefits. Nevertheless, screening rates for PSA tests for prostate cancer detection remain high in clinical practice in older men in the U.S. [ 5 – 10 ]. The major harm is from over-diagnosis: detecting and treating cancers that otherwise would not have become clinically apparent in the patient’s lifetime [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort study

Zanwar

Lin

Kuo

2015

BMC Health Serv Res

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BackgroundAll authorities recommend against prostate specific antigen (PSA) screening in men 75 years and older. However, some primary care physicians (PCPs) continue to have high rates of PSA, with large variation in testing. We assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have PCPs with high or low PSA testing rates.MethodsWe performed a retrospective cohort study using the 2010 Medicare beneficiaries aged 75 or older in Texas, United States who had no prostate cancer in 2007–2009 and had an identifiable PCP. We first identified high vs. low PSA testing PCPs, and then grouped older men in the two PCP groups. We determined health care visits to any provider and to urologists in office and outpatient settings. We estimated the direct medical payments for prostate cancer care for diagnostics, treatments and visits to providers in 2010–2011 using the generalized gamma model with log link function.ResultsIn multilevel, multivariable analyses, 25.4 % (n = 550) of PCPs had PSA testing rates in men aged 75 or older that were significantly higher than the mean rate of all 2,169 Texas PCPs; 29.4 % (n = 638) had rates that were significantly lower. In all, 22,853 vs. 23,929 older men were cared for by PCPs with high vs. low testing rates. Older men cared for by high PSA rate PCPs were more likely to receive a PSA test (OR 3.64, 95 % CI 3.48–3.80), a biopsy (OR 1.16, 95 % CI 1.02–1.31), an ultrasound (OR 1.19, 95 % CI 1.07–1.32) or any radiation treatment (OR 1.31, 95 % CI 1.03–1.66) than men cared for by low PSA rate PCPs. Men with high PSA rate PCPs were 1.21 (95 % CI 1.05–1.39) times more likely to have such outpatient visits. The average annual adjusted Medicare payments for prostate cancer care was $25.60 higher for patients cared for by PCPs with high PSA test rates.ConclusionsOlder men seeing PCPs with high rates of PSA testing undergo more testing and treatments for prostate cancer, with higher Medicare insurance payments. Future studies are needed to delineate whether men seeing PCPs with low testing rates likely received PSA tests from other providers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1265-1) contains supplementary material, which is available to authorized users.

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Is Anyone Listening? Variation in PSA Screening among Providers for Men 75+ before and after United States Preventive Services Task Force Recommendations against It: A Retrospective Cohort Study

Cited by 14 publications

References 42 publications

Exnovation of Low Value Care: A Decade of Prostate‐Specific Antigen Screening Practices

Exnovation of Low Value Care: A Decade of Prostate‐Specific Antigen Screening Practices

Receipt of Cancer Screening Is a Predictor of Life Expectancy

Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort study

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