BACKGROUND/RATIONALE:
In the initial evaluation of prostate cancer (the most-commonly diagnosed non-cutaneous malignancy among US men), a patient's chances of receiving guideline-concordant imaging may be more dependent on the region in which he lives than on his disease characteristics. In order to design and implement policies to optimize prostate cancer imaging, it is important to understand regional variation in prostate cancer imaging as well as the reasons why patients and physicians order it. This Career Development Award seeks to understand these questions and informs a newly funded implementation effort to encourage guideline-concordant prostate cancer imaging.

OBJECTIVE(S):
The goals of the proposed research project are to understand regional variation in prostate cancer imaging. In Specific Aim #1, the researcher will test the thermostat model in two new datasets comprising patients from the VA Central Cancer Registry and SEER-Medicare, representing systems with different payment models, system structures, and eligibility criteria. To understand further the potential causes of imaging variation the project will explore regional prostate cancer imaging rates across delivery systems (Specific Aim #2) and will contribute further depth and detail to these data using semi-structured interviews (Specific Aim #3) to determine physicians' and patients' attitudes regarding imaging. To determine the effects of regional imaging variation, the researcher will construct a decision analytic model (Specific Aim #4) assessing the tradeoffs in cost and disease detection of various imaging strategies. These model-based strategies will be compared to current care in order to determine the magnitude of possible benefit which a new strategy might deliver.

Additionally, this CDA will provide training to the awardee as he becomes a leader in urologic health services research.

METHODS:
In Specific Aim #1, the candidate explored the thermostat model in data from the VA Central Cancer Registry and SEER-Medicare, systems with different payment models, system structures, and eligibility criteria. Aim #1 also explored imaging patterns in the country of Sweden, another healthcare system without direct physician financial incentives. To understand further the potential causes of imaging variation the project explored regional prostate cancer imaging rates across delivery systems (Specific Aim #2) and explored further depth and detail through semi-structured interviews (Specific Aim #3) to determine physicians' and patients' attitudes regarding imaging. To determine the effects of regional imaging variation, the candidate will construct a decision analytic model (Specific Aim #4) assessing the tradeoffs in cost and disease detection of various imaging strategies. These model-based strategies will be compared to current care in order to determine the magnitude of possible benefit which a new strategy might deliver.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Understanding the scope, causes and effects of unwanted regional imaging variation has begun to suggest important strategies to control this problem. The findings from this project, especially the qualitative data on barriers to utilization of imaging guidelines, have informed a VA Investigator Initiated Research grant 1 I01 HX002038-01A2, "A multi-modal, physician-centered intervention to improve guideline-concordant prostate cancer imaging," which has been recommended for funding by HSRD. This is a 10 site implementation trial of a physician focused behavioral intervention to improve guideline-concordant imaging to stage men with incident prostate cancer. The trial should start in February 2018.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX000851-01A1
Link: https://reporter.nih.gov/project-details/8399138

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PUBLICATIONS:

None at this time.

DRA: Cancer, Aging, Older Veterans' Health and Care, Health Systems Science
DRE: Diagnosis, Technology Development and Assessment
Keywords: none
MeSH Terms: none