title: Appropriateness of Prostate Cancer Imaging among Veterans in a Delivery System without Incentives for Overutilization.
abstract: To determine the frequency of appropriate and inappropriate prostate cancer imaging in an integrated health care system.
  
  
  
  Veterans Health Administration Central Cancer Registry linked to VA electronic medical records and Medicare claims (2004-2008).
  
  
  
  We performed a retrospective cohort study of VA patients diagnosed with prostate cancer (N = 45,084). Imaging (CT, MRI, bone scan, PET) use was assessed among patients with low-risk disease, for whom guidelines recommend against advanced imaging, and among high-risk patients for whom guidelines recommend it.
  
  
  
  We found high rates of inappropriate imaging among men with low-risk prostate cancer (41 percent) and suboptimal rates of appropriate imaging among men with high-risk disease (70 percent). Veterans utilizing Medicare-reimbursed care had higher rates of inappropriate imaging [OR: 1.09 (1.03-1.16)] but not higher rates of appropriate imaging. Veterans treated in middle [OR: 0.51 (0.47-0.56)] and higher [OR: 0.50 (0.46-0.55)] volume medical centers were less likely to undergo inappropriate imaging without compromising appropriate imaging.
  
  
  
  Our results highlight the overutilization of imaging, even in an integrated health care system without financial incentives encouraging provision of health care services. Paradoxically, imaging remains underutilized among high-risk patients who could potentially benefit from it most.
authors.affiliation: VA New York Harbor Healthcare System, New York University, New York, NY.|Department of Urology, New York University, New York, NY.|Department of Population Health, New York University, New York, NY.|Cancer Institute, New York University, New York, NY.|Robert F. Wagner Graduate School of Public Service, New York University, New York, NY.
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.affiliation: VA Puget Sound Healthcare System and University of Washington, Seattle, WA.
authors.forename: Elaine Y C
authors.initials: EY
authors.lastname: Hu
authors.affiliation: VA New York Harbor Healthcare System, New York University, New York, NY.|Department of Urology, New York University, New York, NY.|Department of Population Health, New York University, New York, NY.|Cancer Institute, New York University, New York, NY.
authors.forename: Dawn
authors.initials: D
authors.lastname: Walter
authors.affiliation: Department of Population Health, New York University, New York, NY.|Cancer Institute, New York University, New York, NY.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.affiliation: VA New York Harbor Healthcare System, New York University, New York, NY.|Department of Population Health, New York University, New York, NY.|Cancer Institute, New York University, New York, NY.
authors.forename: Scott
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Department of Population Health, New York University, New York, NY.|Cancer Institute, New York University, New York, NY.
authors.forename: Heather T
authors.initials: HT
authors.lastname: Gold
authors.affiliation: VA Puget Sound Healthcare System and University of Washington, Seattle, WA.
authors.forename: Xiao-Hua Andrew
authors.initials: XH
authors.lastname: Zhou
authors.affiliation: Robert Wood Johnson Clinical Scholars Program and Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: VA Puget Sound Healthcare System and University of Washington, Seattle, WA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Zeliadt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D009042:Motivation; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans
keywords: Health care organizations and systems; VA health care system; surgery