title: Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy.
abstract: BACKGROUND
  Although guidelines recommend against prostate-specific antigen (PSA) screening in elderly men with limited life expectancy, screening is common.
  
  
  OBJECTIVE
  We sought to identify medical center characteristics associated with screening in this population.
  
  
  METHODS
  We conducted a prospective study of 622,262 screen-eligible men aged 70+ seen at 104 VA medical centers in 2003.
  
  
  METHODS
  Primary outcome was the percentage of men at each center who received PSA screening in 2003, based on VA data and Medicare claims. Men were stratified into life expectancy groups ranging from favorable (age 70-79 with Charlson score = 0) to limited (age 85+ with Charlson score ≥1 or age 70+ with Charlson score ≥4). Medical center characteristics were obtained from the 1999-2000 VA Survey of Primary Care Practices and publicly available VA data sources.
  
  
  RESULTS
  Among 123,223 (20%) men with limited life expectancy, 45% received PSA screening in 2003. Across 104 VAs, the PSA screening rate among men with limited life expectancy ranged from 25-79% (median 43%). Higher screening was associated with the following center characteristics: no academic affiliation (50% vs. 43%, adjusted RR = 1.14, 95% CI 1.04-1.25), a ratio of midlevel providers to physicians ≥3:4 (55% vs. 45%, adjusted RR = 1.20, 95% CI 1.09-1.32) and location in the South (49% vs. 39% in the West, adjusted RR = 1.25, 95% CI 1.12-1.40). Use of incentives and high scores on performance measures were not independently associated with screening. Within centers, the percentages of men screened with limited and favorable life expectancies were highly correlated (r = 0.90).
  
  
  CONCLUSIONS
  Substantial practice variation exists for PSA screening in older men with limited life expectancy across VAs. The high center-specific correlation of screening among men with limited and favorable life expectancies indicates that PSA screening is poorly targeted according to life expectancy.
authors.affiliation: School of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: So
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Kirby
authors.forename: Kala
authors.initials: K
authors.lastname: Mehta
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.forename: Brenda
authors.initials: B
authors.lastname: Sirovich
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008017:Life Expectancy; D008297:Male; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D058014:Veterans Health / Q000592:standards* / Q000706:statistics & numerical data
chemical_list: D017430:Prostate-Specific Antigen