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Variation in Prostate-Specific Antigen Screening in Men Aged 80 and Older in Fee-for-Service Medicare
[see editorial comments by Dr. Jeff Whittle, pp 757–759]
Article first published online: 22 MAR 2010
DOI: 10.1111/j.1532-5415.2010.02761.x
© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society
Additional Information
How to Cite
Bynum, J., Song, Y. and Fisher, E. (2010), Variation in Prostate-Specific Antigen Screening in Men Aged 80 and Older in Fee-for-Service Medicare. Journal of the American Geriatrics Society, 58: 674–680. doi: 10.1111/j.1532-5415.2010.02761.x
Publication History
- Issue published online: 1 APR 2010
- Article first published online: 22 MAR 2010
- Abstract
- Article
- References
- Cited By
Keywords:
- elderly;
- screening;
- prostate cancer;
- primary care;
- utilization
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.