Journal of General Internal Medicine

, Volume 27, Issue 6, pp 653–660

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
Original Research

DOI: 10.1007/s11606-011-1945-9

Cite this article as:
So, C., Kirby, K.A., Mehta, K. et al. J GEN INTERN MED (2012) 27: 653. doi:10.1007/s11606-011-1945-9

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.

Key words

PSA screening regional variation elderly life expectancy 

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Cynthia So
    • 1
  • Katharine A. Kirby
    • 2
  • Kala Mehta
    • 2
  • Richard M. Hoffman
    • 3
  • Adam A. Powell
    • 4
  • Stephen J. Freedland
    • 5
  • Brenda Sirovich
    • 6
  • Elizabeth M. Yano
    • 7
  • Louise C. Walter
    • 2
  1. 1.School of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Division of GeriatricsSan Francisco VA Medical Center and University of CaliforniaSan FranciscoUSA
  3. 3.New Mexico VA Health Care System, Albuquerque and Department of MedicineUniversity of New MexicoAlbuquerqueUSA
  4. 4.Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System and Department of MedicineUniversity of MinnesotaMinneapolisUSA
  5. 5.Durham VA Medical Center and Duke Prostate CenterDuke UniversityDurhamUSA
  6. 6.White River Junction VAWindsorUSA
  7. 7.VA HSR&D Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health System and Department of Health ServicesUCLA School of Public HealthLos AngelesUSA

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