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.

项目概要/摘要 用于早期发现前列腺癌的前列腺特异性抗原（PSA）筛查已得到广泛应用 在美国，老年男性中采用这种方法，包括那些预期寿命有限的男性。这样的筛选是 基于普遍的信念，尽管存在不确定性，但筛查始终是最安全的行动方案 PSA 筛查的好处。因此，该提案创新性地利用了基于 VA 和 Medicare 索赔的 数据和电子健康记录，以确定与 PSA 筛查和下游相关的因素 对老年男性进行一系列年龄增长和合并症筛查后的后果。 其中包括几项指南推荐的预期寿命为 10 年的男性 筛查，以及预期寿命有限的男性，筛查不太可能有益。这样的数据 对于许多正在考虑的老年男性来说，这是明智的 PSA 筛查决策的基础 筛查并制定质量措施，奖励临床医生避免过度检测。 该申请提议对 826,908 名 65 岁及以上男性进行队列研究，这些男性在 104 岁就诊 2002 年和 2003 年期间在退伍军人事务部 (VA) 机构工作，无前列腺癌病史、PSA 升高或 前列腺癌症状。 VA 数据和医疗保险索赔将用于衡量 PSA 的表现 2003 年期间的检测以及卫生系统、提供者和患者层面的筛查和检测决定因素 筛选后的下游后果。男性子集也将被选择以获得更富有 电子健康记录中有关筛查的其他决定因素和后果的临床详细信息。 该项目的目标是 1) 确定相关的卫生系统、提供者和患者因素 对年龄较大且患有合并症的老年男性进行 PSA 筛查； 2）量化 现实世界的下游后果（例如 PSA 检测、前列腺活检、癌症诊断、治疗、 和并发症）在对老年男性进行 PSA 筛查后 3 年内 年龄增长和合并症； 3) 确定卫生系统、提供者和患者因素 与这些下游后果相关。与 PSA 筛查和启动相关的因素 一系列下游后果中的每一步都将根据预期寿命来确定 确定需要在哪些方面采取有针对性的干预措施，以阻止对老年男性进行过度检测。