Prostate-Specific Antigen Practices and Outcomes in the Elderly

项目摘要/摘要 前列腺特异性抗原(PSA)筛查用于前列腺癌的早期检测已被广泛应用 在美国被老年男性采用，包括那些预期寿命有限的人。这样的筛选是 根植于普遍的信念，即筛查始终是最安全的行动方案，尽管不确定 PSA筛查的好处。因此，这项提案创新地使用了基于退伍军人保险和联邦医疗保险的索赔 数据和电子健康记录，以确定与PSA筛查和下游相关的因素 对老年男性进行高龄和并存疾病筛查后的后果。 这包括一些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，筛查不太可能对他们有利。这样的数据 是许多老年男性做出知情PSA筛查决定的基础，这些老年男性正在考虑 筛查和制定质量措施，奖励避免过度检测的临床医生。 这项申请提出了一项队列研究，研究对象为826,908名65岁及以上的男性，他们的年龄为104岁 退伍军人事务部(VA)设施在2002至2003年间，没有前列腺癌、PSA升高或 前列腺癌症状。退伍军人管理局的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 筛查后的下游后果。男性的子组也将被选为更富有的人 来自电子健康记录的有关其他决定因素和筛查结果的临床细节。 该项目的目标是1)确定卫生系统、提供者和患者的相关因素 在老年男性中进行PSA筛查，包括高龄和并存疾病的范围；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)在老年男性PSA筛查后的3年内 年龄增长和并存疾病；以及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 下游后果级联中的每一步都将根据预期寿命确定 确定在哪些方面需要有针对性的干预措施，以阻止对老年男性进行过度检测。

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.