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: 7714951
• 负责人: Louise C. Walter
• 金额: $ 46.36万
• 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 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7714951
• 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; Randomized Controlled Clinical Trials; Recording of previous events; Rewards; Screening for Prostate Cancer; Screening procedure; Services; Socioeconomic Factors; Staging; Symptoms; Testing; United States; Universities; Veterans; Work; aged; cancer diagnosis; cohort; combat; deprivation; design; human old age (65+); improved; innovation; men; older men; public health relevance

DESCRIPTION (provided by applicant): 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 application 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. PUBLIC HEALTH RELEVANCE: This study will have unique public health importance because it will be the largest "real world" study of how PSA screening is being targeted among elderly men according to life expectancy and the downstream consequences associated with these screening decisions. The findings of this study are critical to improving PSA screening decisions in elderly men as well as to improving national screening guidelines, decision aids, and quality measures in this area.

描述（由申请人提供）：前列腺特异性抗原（PSA）筛查以早期检测到前列腺癌的早期发现，在美国的老年男性中，包括预期寿命有限的老年人中被广泛采用。这种筛查是基于普遍的信念，即尽管PSA筛选的好处不确定，但筛查始终是最安全的行动方案。因此，该应用程序可以创新使用基于VA和Medicare索赔的数据和电子健康记录，以确定与PSA筛查相关的因素以及在筛查老年男性筛查跨年龄和合并症的筛查后的下游后果。这包括有10年预期寿命的男性为他们提供筛查，其中有几个指南建议筛查，而预期寿命有限的男性则不太可能受益。这些数据对于许多正在考虑筛查和制定质量措施的老年男性中的知情PSA筛查决策至关重要，从而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岁以上男性的队列研究，这些研究在2002年和2003年期间在104名退伍军人事务（VA）设施中看到，没有前列腺癌，PSA升高或前列腺癌症状的病史。 VA数据和Medicare索赔将用于衡量2003年期间PSA测试的性能以及筛查的健康系统，提供者和患者级别的决定因素以及筛查后的下游后果。还将选择男性子集，以从电子健康记录中获得有关其他决定因素和筛查后果的更丰富的临床细节。该项目的目的是1）确定与年龄和合并症相关的老年男性PSA筛查相关的健康系统，提供者和患者因素； 2）在PSA筛查后的3年中，量化了现实世界下游后果（例如，PSA测试，前列腺活检，癌症诊断，治疗和并发症）。 3）确定与这些下游后果相关的健康系统，提供者和患者因素。将根据预期寿命确定与PSA筛查和启动下游后果级联的每个步骤相关的因素，以确定需要在何处进行靶向干预措施，以阻止老年男性的过度测试。公共卫生相关性：这项研究将具有独特的公共卫生重要性，因为它将是根据预期寿命以及与这些筛查决策相关的下游后果对PSA筛查如何针对PSA筛查的最大“现实世界”研究。这项研究的结果对于改善老年男性的PSA筛查决策以及改善国家筛查指南，决策AID和该领域的质量措施至关重要。