与预期寿命有限的老年退伍军人中 PSA 筛查相关的医疗中心特征。
Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy.
机构信息
School of Medicine, University of California, San Francisco, CA, USA.
出版信息
J Gen Intern Med. 2012 Jun;27(6):653-60. doi: 10.1007/s11606-011-1945-9. Epub 2011 Dec 17.
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.
背景
尽管指南建议对预期寿命有限的老年男性不进行前列腺特异性抗原（PSA）筛查，但这种筛查仍很常见。
目的
我们旨在确定与该人群筛查相关的医疗中心特征。
设计/参与者：我们对 2003 年在 104 家退伍军人事务部医疗中心就诊的 622262 名 70 岁以上符合筛查条件的男性进行了前瞻性研究。
主要措施
主要结局是根据退伍军人事务部数据和医疗保险索赔，确定每个中心接受 PSA 筛查的男性比例，2003 年。将男性分为预期寿命组，从有利（年龄 70-79 岁，Charlson 评分=0）到有限（年龄 85 岁以上，Charlson 评分≥1 或年龄 70 岁以上，Charlson 评分≥4）。从 1999-2000 年退伍军人事务部初级保健实践调查和退伍军人事务部公开可用数据来源中获得医疗中心特征。
主要结果
在 123223 名（20%）预期寿命有限的男性中，45%在 2003 年接受了 PSA 筛查。在 104 家退伍军人事务部中，预期寿命有限的男性 PSA 筛查率从 25%-79%（中位数 43%）不等。更高的筛查率与以下中心特征相关：无学术隶属关系（50%与 43%，调整后的 RR=1.14，95%CI 1.04-1.25）、中级保健提供者与医生的比例≥3:4（55%与 45%，调整后的 RR=1.20，95%CI 1.09-1.32）和位于南部（49%与西部的 39%，调整后的 RR=1.25，95%CI 1.12-1.40）。使用激励措施和绩效措施评分高与筛查无关。在中心内，预期寿命有限和有利的男性接受筛查的百分比高度相关（r=0.90）。
结论
退伍军人事务部各医疗中心之间，对预期寿命有限的老年男性进行 PSA 筛查存在大量实践差异。预期寿命有限和有利的男性之间筛查的高中心特异性相关性表明，根据预期寿命，PSA 筛查的针对性很差。
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