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Published on: November 2, 2013
Variation in prostate-specific antigen screening in men aged 80 and older in fee-for-service Medicare
Julie Bynum1, Yunjie Song, Elliott Fisher
1Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA. julie.bynum@dartmouth.edu
Objectives:
To determine the rate of prostate-specific antigen (PSA) screening in men aged 80 and older in Medicare and to examine geographic variation in screening rates across the U.S.
Design:
Retrospective cohort study of variation across hospital referral regions using administrative data.
Setting:
National random sample in fee-for-service Medicare.
Participants:
Medicare beneficiaries aged 80 and older in 2003.
Measurements:
Percentage of men aged 80 and older screened using the PSA test.
Results:
The national rate of PSA screening in men aged 80 and older was 17.2%, but there was wide variation across regions (<2-38%). Higher PSA screening in a region was positively associated with greater total costs (correlation coefficient (r)=0.49, P<.001), greater intensive care unit use at the end of life (r=0.46, P<.001), and greater number of unique physicians seen (r=0.36, P<.001). PSA screening was negatively associated with proportion of beneficiaries using a primary care physician as opposed to a medical subspecialist for the predominance of ambulatory care (r=-0.38, P<.001).
Conclusion:
PSA screening in men aged 80 and older is common practice, although its frequency is highly variable across the United States. Its association with fragmented physician care and aggressive end-of-life care may reflect less reliance on primary care and consequent difficulty informing patients of the potential harms and low likelihood of benefit of this procedure.
Insights
Prostate-specific antigen (PSA) screening is common in men over 80, with rates varying widely nationwide. Higher screening rates correlate with increased healthcare costs and fragmented care, suggesting potential issues in patient counseling.
Area of Science:
- Geriatric Medicine
- Urology
- Health Services Research
Background:
- Prostate-specific antigen (PSA) screening is a common urological procedure.
- Understanding screening patterns in elderly populations is crucial for evidence-based practice.
Purpose of the Study:
- To determine the rate of PSA screening in men aged 80 and older within Medicare.
- To examine geographic variations in PSA screening rates across the United States.
Main Methods:
- Retrospective cohort study utilizing administrative data from fee-for-service Medicare.
- Analysis of Medicare beneficiaries aged 80 and older in 2003.
- Examined screening rates across hospital referral regions.
Main Results:
- The national PSA screening rate for men aged 80+ was 17.2%, with significant regional variation (under 2% to 38%).
- Higher screening rates were associated with increased total costs, intensive care unit use at end-of-life, and seeing more unique physicians.
- Screening rates were negatively associated with primary care physician utilization.
Conclusions:
- PSA screening is frequently performed in men aged 80 and older, but utilization varies significantly by region.
- Associations with fragmented care and aggressive end-of-life care suggest potential challenges in communicating screening risks and benefits to this population.
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