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Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support

Anand Shah1, Thomas J Polascik1, Daniel J George1

  • 1Duke University, Durham, NC, USA.

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Implementing a risk-stratified prostate cancer screening algorithm in an EHR increased screening in high-risk men and decreased it in low-risk men. This strategy shows promise for optimizing cancer screening practices.

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Area of Science:

  • Oncology
  • Health Informatics
  • Preventive Medicine

Background:

  • Implementation of risk-stratified cancer screening guidance within healthcare systems is not well understood.
  • Prostate cancer screening guidelines often lack clear implementation strategies.

Purpose of the Study:

  • To analyze the initial implementation of a risk-stratified prostate cancer screening algorithm.
  • To assess changes in screening practices after algorithm integration into an electronic health record (EHR).

Main Methods:

  • A preliminary analysis compared men pre- and post-implementation of the screening algorithm.
  • The algorithm was integrated into EHR for personalized reminders and provider alerts with prostate-specific antigen (PSA) results.
  • Logistic repeated measures mixed models analyzed differences in screening criteria adherence.

Main Results:

  • The proportion of men meeting screening criteria rose from 49.3% to 68.0% post-implementation (p < 0.001).
  • This increase occurred across all demographics and clinics, with adjusted odds of meeting criteria 6.5 times higher post-implementation.
  • The percentage of men with a PSA result remained stable (55.3% vs. 55.0%).

Conclusions:

  • EHR-based algorithm implementation rapidly shifted practice towards increased screening in higher-risk individuals and decreased screening in lower-risk groups.
  • This preliminary study indicates successful adaptation of risk-stratified screening.
  • Future research will focus on cost-effectiveness and long-term outcomes.