Prostate-Specific Antigen Practices and Outcomes in the Elderly

老年人前列腺特异性抗原的实践和结果

• 批准号: 8259539
• 负责人: Louise C. Walter
• 金额: $ 42.5万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8259539
• 关键词: Adopted; Adverse effects; Advisory Committees; Age; Androgens; Area; Belief; Biopsy; Clinical; Cohort Studies; Comorbidity; Data; Databases; Decision Aid; Decision Making; Development; Disease; Elderly; Elderly man; Electronic Health Record; Event; Gender; Guidelines; Health system; Intervention; Life Expectancy; Link; Location; Malignant neoplasm of prostate; Marital Status; Measures; Medicare; Medicare claim; Minority; Outcome; Patients; Performance; Preventive; Primary Health Care; Process; Prostate; Prostate-Specific Antigen; Provider; Public Health; Publishing; Race; Radiation; Radical Prostatectomy; Recording of previous events; Rewards; Screening for Prostate Cancer; Screening procedure; Services; Socioeconomic Factors; Staging; Symptoms; Testing; United States; Universities; Veterans; Work; abstracting; aged; cancer diagnosis; cohort; combat; deprivation; design; human old age (65+); improved; innovation; men; older men; randomized trial

Project Summary/Abstract Prostate-specific antigen (PSA) screening for the early detection of prostate cancer has been widely adopted in the U.S. among elderly men, including those with limited life expectancy. Such screening is grounded in pervasive beliefs that screening is always the safest course of action, despite the uncertain benefit of PSA screening. Therefore, this proposal makes innovative use of VA and Medicare claims-based data and electronic health records to determine factors associated with PSA screening and the downstream consequences following screening in elderly men across a spectrum of advancing age and comorbid illness. This includes men with favorable 10-year life expectancy for whom several guidelines recommend screening, and men with limited life expectancy for whom screening is unlikely to be beneficial. Such data are fundamental for informed PSA screening decisions among the many elderly men who are considering screening and for the development of quality measures that reward clinicians for avoiding excessive testing. This application proposes a cohort study of 826,908 men aged 65 years and older who were seen at 104 Veterans Affairs (VA) facilities during 2002 and 2003, without a history of prostate cancer, elevated PSA, or prostate cancer symptoms. VA data and Medicare claims will be used to measure the performance of PSA testing during 2003 as well as the health-system, provider, and patient-level determinants of screening and the downstream consequences following screening. Subsets of men will also be selected to obtain richer clinical detail from electronic health records about additional determinants and consequences of screening. The aims of this project are 1) to determine the health-system, provider, and patient factors associated with PSA screening in elderly men across a spectrum of advancing age and comorbid illness; 2) to quantify the real world downstream consequences (e.g., PSA testing, prostate biopsies, cancer diagnosis, treatment, and complications) during the 3 years following PSA screening in elderly men across a spectrum of advancing age and comorbid illness; and 3) to identify health-system, provider, and patient factors associated with these downstream consequences. Factors associated with PSA screening and initiating each step in the cascade of downstream consequences will be identified according to life expectancy to determine where targeted interventions are needed to discourage excessive testing in elderly men.

项目摘要/摘要 前列腺特异性抗原（PSA）筛查以早期检测到前列腺癌 在美国，包括预期寿命有限的老年人中通过。这样的筛选是 基于普遍的信念，即筛查始终是最安全的行动方案，尽管不确定 PSA筛选的好处。因此，该提案是对基于VA和Medicare索赔的创新使用 数据和电子健康记录以确定与PSA筛查和下游相关的因素 筛查老年男子在各种各样的年龄和合并症中筛查后的后果。 这包括有良好预期寿命的男性，有几个指南建议他们 筛查和预期寿命有限的男性对筛查不太可能是有益的。这样的数据 对于许多正在考虑 筛查和制定质量措施，以奖励临床医生避免过度测试。 该申请提出了一项对826,908名65岁及以上男性的队列研究，他们在104岁时见过 2002年和2003年的退伍军人事务（VA）设施，没有前列腺癌的病史，PSA升高或 前列腺癌症状。 VA数据和Medicare索赔将用于衡量PSA的性能 2003年的测试以及筛查和患者级别的健康系统，提供者和筛查的决定因素 筛选后的下游后果。还将选择男性的子集以获得更丰富的 电子健康记录中有关其他决定因素和筛查后果的临床细节。 该项目的目的是1）确定与与患者有关的健康系统，提供者和患者因素 PSA筛查老年男性，各种各样的年龄和合并症； 2）量化 现实世界的下游后果（例如，PSA测试，前列腺活检，癌症诊断，治疗， 和并发症）在PSA筛查后的3年中，老年男性遍布一系列 增长年龄和合并症； 3）确定健康系统，提供者和患者因素 与这些下游后果相关。与PSA筛选和启动相关的因素 根据预期寿命，将确定级联下游后果的每一步 确定需要在何处采取针对性的干预措施，以阻止老年男性的过度测试。