Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

HSR Citation Abstract

Search | Search by Center | Search by Source | Keywords in Title

Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy.

So C, Kirby KA, Mehta K, Hoffman RM, Powell AA, Freedland SJ, Sirovich B, Yano EM, Walter LC. Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy. Journal of general internal medicine. 2012 Jun 1; 27(6):653-60.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

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 VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions



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.





Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.