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Makarov DV, Hu E, Walter R, Braithwaite S, Sherman S, Zhou XA, Gross C, Zeliadt SB. Regional Variation and Time Trends in Prostate Cancer Imaging Utilization among Veterans with Incident Disease. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 10; San Diego, CA.
Encouraging appropriate use of imaging to stage incident prostate cancer is a challenging problem Highlighted recently as Physician Quality Reporting System quality measure and in Choosing Wisely Campaign. Aim: to determine frequency of appropriate and inappropriate use of prostate cancer imaging in an integrated healthcare system Hypothesis 1: Inappropriate prostate cancer imaging rates would be lower than those reported in fee for service settings Hypothesis 2: Appropriate prostate cancer imaging rates would be higher than those reported in fee-for-service settings Retrospective Cohort Study Unit of Analysis: Individual Patient Inclusion criteria Men diagnosed with prostate cancer from the VA Central Cancer Registry Years: 2004-2008 N = 45,084 Dependent Variable: Imaging received in VA and Medicare Independent Variables: Environmental-, health system- and patient-level factors associated with the decision to use imaging Analysis stratified by disease risk Guidelines recommend against advanced imaging in patients with low risk disease Guidelines recommend advanced imaging for patients with higher risk disease Advanced imaging is often over-utilized, even in an integrated healthcare system without financial incentives to encourage the provision of health care services Imaging often under-utilized by high risk patients who could potentially benefit most Guideline-discordant association between imaging and aggressive disease characteristics suggests that policy efforts only calling attention to inappropriate imaging (e.g. Choosing Wisely) may be insufficient to correct it
