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Health Services Research & Development

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CDA 11-257 – HSR&D Study

 
CDA 11-257
Optimizing Imaging Use Among Veterans with Prostate Cancer
Danil V Makarov MD MHS
Manhattan Campus of the VA NY Harbor Healthcare System, New York, NY
New York, NY
Funding Period: October 2012 - September 2017

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.


External Links for this Project

NIH Reporter

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

Dimensions for VA

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If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project

PUBLICATIONS:

Journal Articles

  1. Presley CJ, Raldow AC, Cramer LD, Soulos PR, Long JB, Yu JB, Makarov DV, Gross CP. A new approach to understanding racial disparities in prostate cancer treatment. Journal of geriatric oncology. 2013 Jan 1; 4(1):1-8. [view]
  2. Makarov DV, Sedlander E, Braithwaite RS, Sherman SE, Zeliadt S, Gross CP, Curnyn C, Shedlin M. A qualitative study to understand guideline-discordant use of imaging to stage incident prostate cancer. Implementation science : IS. 2016 Sep 2; 11(1):118. [view]
  3. Mittakanti HR, Thomas IC, Shelton JB, Makarov DV, Skolarus TA, Cooperberg MR, Chung BI, Sonn GA, Brooks JD, Leppert JT. Accuracy of Prostate-Specific Antigen Values in Prostate Cancer Registries. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016 Oct 10; 34(29):3586-3587. [view]
  4. Makarov DV, Hu EY, Walter D, Braithwaite RS, Sherman S, Gold HT, Zhou XH, Gross CP, Zeliadt SB. Appropriateness of Prostate Cancer Imaging among Veterans in a Delivery System without Incentives for Overutilization. Health services research. 2016 Jun 1; 51(3):1021-51. [view]
  5. Li H, Gail MH, Braithwaite RS, Gold HT, Walter D, Liu M, Gross CP, Makarov DV. Are hospitals “keeping up with the Joneses”?: Assessing the spatial and temporal diffusion of the surgical robot. Healthcare (Amsterdam, Netherlands). 2014 Jul 1; 2(2):152-157. [view]
  6. McClintock TR, Chen Y, Parvez F, Makarov DV, Ge W, Islam T, Ahmed A, Rakibuz-Zaman M, Hasan R, Sarwar G, Slavkovich V, Bjurlin MA, Graziano JH, Ahsan H. Association between arsenic exposure from drinking water and hematuria: results from the Health Effects of Arsenic Longitudinal Study. Toxicology and applied pharmacology. 2014 Apr 1; 276(1):21-7. [view]
  7. Makarov DV, Chrouser K, Gore JL, Marachie J, Nielsen ME, Tessier C, Fagerlin A. AUA White Paper on Implementation of Shared Decision Making into Urological Practice. The Journal of urology. 2016 Sep 1; 3(5):355-363. [view]
  8. Anderson CB, Penson DF, Ni S, Makarov DV, Barocas DA. Centralization of radical prostatectomy in the United States. The Journal of urology. 2013 Feb 1; 189(2):500-6. [view]
  9. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, Freedland SJ, Greene K, Klotz LH, Makarov DV, Nelson JB, Rodrigues G, Sandler HM, Taplin ME, Treadwell JR. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. The Journal of urology. 2018 Mar 1; 199(3):683-690. [view]
  10. Wei J, Wang Z, Makarov D, Li X. Current treatments and novel therapeutic targets for castration resistant prostate cancer with bone metastasis. American journal of clinical and experimental urology. 2013 Dec 25; 1(1):30-8. [view]
  11. Acosta-Gonzalez G, Qin J, Wieczorek R, Melamed J, Deng FM, Zhou M, Makarov D, Ye F, Pei Z, Pincus MR, Lee P. De novo large cell neuroendocrine carcinoma of the prostate, case report and literature review. American journal of clinical and experimental urology. 2014 Dec 25; 2(4):337-42. [view]
  12. Ciprut S, Sedlander E, Watts KL, Matulewicz RS, Stange KC, Sherman SE, Makarov DV. Designing a theory-based intervention to improve the guideline-concordant use of imaging to stage incident prostate cancer. Urologic oncology. 2018 May 1; 36(5):246-251. [view]
  13. Lloyd S, Buscariollo DL, Gross CP, Makarov DV, Yu JB. Determinants of enrollment in cancer clinical trials: the relationship between the current state of knowledge, societal disease burden, and randomized clinical trial enrollment. Journal of the National Comprehensive Cancer Network : JNCCN. 2013 Aug 1; 11(8):928-36. [view]
  14. Stone BV, Cohn MR, Donin NM, Schulster M, Wysock JS, Makarov DV, Bjurlin MA. Evaluation of Unplanned Hospital Readmissions After Major Urologic Inpatient Surgery in the Era of Accountable Care. Urology. 2017 Nov 1; 109:94-100. [view]
  15. Becker DJ, Lin D, Lee S, Levy BP, Makarov DV, Gold HT, Sherman S. Exploration of the ASCO and ESMO Value Frameworks for Antineoplastic Drugs. Journal of oncology practice / American Society of Clinical Oncology. 2017 Jul 1; 13(7):e653-e665. [view]
  16. Wollin DA, Makarov D. Extended pelvic lymph node dissection for prostate cancer: do more nodes mean better survival? Oncology (Williston Park, N.Y.). 2014 Jul 1; 28(7):601-2. [view]
  17. Loeb S, Folkvaljon Y, Makarov DV, Bratt O, Bill-Axelson A, Stattin P. Five-year nationwide follow-up study of active surveillance for prostate cancer. European Urology. 2015 Feb 1; 67(2):233-8. [view]
  18. Wollin DA, Makarov DV. Guideline of Guidelines: Imaging of Localized Prostate Cancer. BJU international. 2015 Oct 1; 116(4):526-30. [view]
  19. Loeb S, Walter D, Curnyn C, Gold HT, Lepor H, Makarov DV. How Active is Active Surveillance? Intensity of Followup during Active Surveillance for Prostate Cancer in the United States. The Journal of urology. 2016 Sep 1; 196(3):721-6. [view]
  20. Loeb S, Folkvaljon Y, Robinson D, Makarov DV, Bratt O, Garmo H, Stattin P. Immediate versus delayed prostatectomy: Nationwide population-based study (.). Scandinavian journal of urology. 2016 Aug 1; 50(4):246-54. [view]
  21. Becker DJ, Levy BP, Gold HT, Sherman SE, Makarov DV, Schreiber D, Wisnivesky JP, Pass HI. Influence of Extent of Lymph Node Evaluation on Survival for Pathologically Lymph Node Negative Non-Small Cell Lung Cancer. American journal of clinical oncology. 2018 Aug 1; 41(8):820-825. [view]
  22. Borofsky MS, Walter D, Li H, Shah O, Goldfarb DS, Sosa RE, Makarov DV. Institutional characteristics associated with receipt of emergency care for obstructive pyelonephritis at community hospitals. The Journal of urology. 2015 Mar 1; 193(3):851-6. [view]
  23. Prabhu V, Alukal JP, Laze J, Makarov DV, Lepor H. Long-term satisfaction and predictors of use of intracorporeal injections for post-prostatectomy erectile dysfunction. The Journal of urology. 2013 Jan 1; 189(1):238-42. [view]
  24. Bjurlin MA, Walter D, Taksler GB, Huang WC, Wysock JS, Sivarajan G, Loeb S, Taneja SS, Makarov DV. National trends in the utilization of partial nephrectomy before and after the establishment of AUA guidelines for the management of renal masses. Urology. 2013 Dec 1; 82(6):1283-9. [view]
  25. Guma S, Maglantay R, Lau R, Wieczorek R, Melamed J, Deng FM, Zhou M, Makarov D, Lee P, Pincus MR, Pei ZH. Papillary urothelial carcinoma with squamous differentiation in association with human papilloma virus: case report and literature review. American journal of clinical and experimental urology. 2016 Jan 28; 4(1):12-6. [view]
  26. Makarov DV, Loeb S, Ulmert D, Drevin L, Lambe M, Stattin P. Prostate cancer imaging trends after a nationwide effort to discourage inappropriate prostate cancer imaging. Journal of the National Cancer Institute. 2013 Sep 4; 105(17):1306-13. [view]
  27. Gyftopoulos S, Smith SW, Simon E, Kuznetsova M, Horwitz LI, Makarov DV. Qualitative Study to Understand Ordering of CT Angiography to Diagnose Pulmonary Embolism in the Emergency Room Setting. Journal of the American College of Radiology : JACR. 2018 Sep 1; 15(9):1276-1284. [view]
  28. Prabhu V, Taksler GB, Sivarajan G, Laze J, Makarov DV, Lepor H. Radical prostatectomy improves and prevents age dependent progression of lower urinary tract symptoms. The Journal of urology. 2014 Feb 1; 191(2):412-7. [view]
  29. Makarov DV, Soulos PR, Gold HT, Yu JB, Sen S, Ross JS, Gross CP. Regional-Level Correlations in Inappropriate Imaging Rates for Prostate and Breast Cancers: Potential Implications for the Choosing Wisely Campaign. JAMA oncology. 2015 May 1; 1(2):185-94. [view]
  30. Bjurlin MA, Makarov DV. Reply: To PMID 24295245. Urology. 2013 Dec 1; 82(6):1289-90. [view]
  31. Borofsky MS, Walter D, Shah O, Goldfarb DS, Mues AC, Makarov DV. Surgical decompression is associated with decreased mortality in patients with sepsis and ureteral calculi. The Journal of urology. 2013 Mar 1; 189(3):946-51. [view]
  32. Borofsky MS, Makarov DV. Take home messages: outcomes analysis. American Urology Association AUA News. 2013 Jul 1; 18(7):7. [view]
  33. Makarov DV, Li H, Lepor H, Gross CP, Blustein J. Teaching Hospitals and the Disconnect Between Technology Adoption and Comparative Effectiveness Research: The Case of the Surgical Robot. Medical care research and review : MCRR. 2017 Jun 1; 74(3):369-376. [view]
  34. Makarov DV, Yu JB, Desai RA, Penson DF, Gross CP. The association between diffusion of the surgical robot and radical prostatectomy rates. Medical care. 2011 Apr 1; 49(4):333-9. [view]
  35. Ma X, Wang R, Long JB, Ross JS, Soulos PR, Yu JB, Makarov DV, Gold HT, Gross CP. The cost implications of prostate cancer screening in the Medicare population. Cancer. 2014 Jan 1; 120(1):96-102. [view]
  36. Sivarajan G, Taksler GB, Walter D, Gross CP, Sosa RE, Makarov DV. The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy. Medical care. 2015 Jan 1; 53(1):71-8. [view]
  37. Batouli A, Jahanshahi P, Gross CP, Makarov DV, Yu JB. The global cancer divide: relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries. Journal of epidemiology and global health. 2014 Jun 1; 4(2):115-24. [view]
  38. Kirk PS, Borza T, Shahinian VB, Caram MEV, Makarov DV, Shelton JB, Leppert JT, Blake RM, Davis JA, Hollenbeck BK, Sales A, Skolarus TA. The implications of baseline bone-health assessment at initiation of androgen-deprivation therapy for prostate cancer. BJU international. 2018 Apr 1; 121(4):558-564. [view]
  39. Borofsky MS, Ohmann E, Makarov DV. The transition to value-based care in urology. AUA update series. 2013 Jan 1; 32(31):309-320. [view]
  40. Prabhu V, Lee T, Loeb S, Holmes JH, Gold HT, Lepor H, Penson DF, Makarov DV. Twitter response to the United States Preventive Services Task Force recommendations against screening with prostate-specific antigen. BJU international. 2015 Jul 1; 116(1):65-71. [view]
  41. Bratt O, Folkvaljon Y, Hjälm Eriksson M, Akre O, Carlsson S, Drevin L, Franck Lissbrant I, Makarov D, Loeb S, Stattin P. Undertreatment of Men in Their Seventies with High-risk Nonmetastatic Prostate Cancer. European Urology. 2015 Jul 1; 68(1):53-8. [view]
Journal Other

  1. Makarov DV, Holmes-Rovner M, Rovner DR, Averch T, Barry MJ, Chrouser K, Gee WF, Goodrich K, Haynes M, Krahn M, Saigal C, Sox HC, Stacey D, Tessier C, Waterhouse RL, Fagerlin A. Shared Decision Making and Prostate Cancer Screening [White paper] American Urological Association and Society for Medical Decision Making Quality Improvement Summit Proceedings. [Abstract]. Urology Practice. 2016 Apr 2; https://doi.org/10.1016/j.urpr.2017.11.005. [view]
  2. Loeb S, Stork B, Gold HT, Stout NK, Makarov DV, Weight CJ, Borgmann H. Tweet this: how advocacy for breast and prostate cancers stacks up on social media. BJU international. 2017 Jun 7; 120(4):461-463. [view]
Online News Media Articles

  1. Makarov DV, Fagerlin A, Chrouser K, Gore JL, Maranchie J, Nielsen ME, Saigal C, Tessier C. AUA White Paper on Implementation of Shared Decision Making into Urological Practice. American Urological Association Guidelines [Internet]. 2015 Jan 1. Available from: http://www.auanet.org/guidelines/shared-decision-making. [view]


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

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