Changing Provider PSA Screening Behavior Using Best Practice Advisories: Interventional Study in a Multispecialty...

Area of Science:

• Urology
• Preventive Medicine
• Health Informatics

Background:

• Most guidelines advise against prostate-specific antigen (PSA) screening for prostate cancer in men aged 70 years and older.
• Adherence to these guidelines for PSA testing is inconsistent.

Purpose of the Study:

• To evaluate the impact of a Best Practice Advisory (BPA) alert within an electronic medical record (EMR) system on PSA screening rates.
• To determine if BPA interventions can modify PSA screening behavior in men aged 70 and above.

Main Methods:

• An interventional study conducted from 2013 to 2017 among men aged 70+ without prior prostate cancer history at Kaiser Permanente Northern California.
• A BPA alert was implemented in the EMR system on October 15, 2015.
• Interrupted time series analysis compared PSA testing rates pre-BPA (Jan 2013-Oct 2015) and post-BPA (Oct 2015-Dec 2017).

Main Results:

• Following BPA activation, PSA screening rates decreased significantly from 36.0 to 14.9 per 100 person-years (rate ratio = 0.415).
• The BPA intervention led to a 58.5% decline in inappropriate PSA testing.
• The analysis revealed a rapid, substantial, and sustained reduction in PSA test ordering, with decreased temporal variation.

Conclusions:

• Implementing a BPA alert in EMR systems effectively reduces inappropriate PSA screening in men aged 70 and older.
• This intervention demonstrates a significant decrease in screening rates and improved adherence to clinical guidelines.