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MP25-10 DECLINE IN PROSTATE SPECIFIC ANTIGEN SCREENING AMONG PRIMARY CARE PHYSICIANS IN RESPONSE TO UNITED STATES PREVENTATIVE SERVICES TASK FORCE RECOMMENDATIONS
THE JOURNAL OF UROLOGYâ
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Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
direction toward reduction in over diagnosis and over treatment of clinically insignificant prostate cancer or stage migration toward more locally advanced disease due to lost opportunity in diagnosing and treating early clinically significant prostate cancer will remain to be seen.
Source of Funding: None
MP25-10 DECLINE IN PROSTATE SPECIFIC ANTIGEN SCREENING AMONG PRIMARY CARE PHYSICIANS IN RESPONSE TO UNITED STATES PREVENTATIVE SERVICES TASK FORCE RECOMMENDATIONS Jonathan Shoag, Khushabu Kasabwala*, Sameer Mittal, Joshua Halpern, Daniel Lee, Jim Hu, Christopher Barbieri, New York, NY INTRODUCTION AND OBJECTIVES: The United States Preventative Services Task Force (USPSTF) controversially recommended against prostate specific antigen (PSA) screening in its guideline released in October of 2011. Previous studies of national screening rates have found a significant decrease in PSA screening after the release of the USPSTF recommendations, however these are limited by their reliance on patient self report. The National Ambulatory Medical Care Survey (NAMCS) is a conducted annually by the Centers for Disease Control and Prevention (CDC), and collects data on PSA screening from records of medical visits. In this study, we aim to determine the frequency of PSA testing by primary care physicians before and after release of the USPSTF guidelines. METHODS: NAMCS is based on a sample of visits to nonfederal, office-based physicians. The basic sampling unit for the NAMCS is the physician-patient visit. All analysis was performed in accordance with NCHS recommendations accounting for the complex survey design, and Pearson0 s chi-squared test was used for all statistical comparisons. RESULTS: In men over forty seeing their primary care doctor for preventative care, the rate of PSA testing by year is shown in Figure 1. Comparing the years prior to the release of the USPSTF guideline and 2012, the rate of testing decreased from 28.3% (95% CI 25.2% to 31.5%) to 15.6% (95% CI 11.8% to 20.4%, p<0.001). The rate of testing by age is shown in Figure 2. The American Urological Association currently recommends joint decision-making in deciding on screening in men aged 55 to 69. The rate of screening among these men decreased from 33.0% (95% CI 29.4% to 36.8%) in 2002-2010 to 18.7% (95% CI 13.8% to 24.9%) in 2012 (p<0.001). CONCLUSIONS: Office-based prostate cancer screening decreased 45% after the release of the 2012 USPSTF guideline. This report, combined with results from other sources, suggest that the use of PSA screening is rapidly declining in primary care practice.
Source of Funding: None
MP25-11 PHYSICIAN-LEVEL VARIATION IN THE USE OF OBSERVATION FOR LOCALIZED PROSTATE CANCER Mark Tyson*, Amy Graves, Daniel Barocas, Sam Chang, David Penson, Matthew Resnick, Nashville, TN INTRODUCTION AND OBJECTIVES: The Center for Medicare & Medicaid Services is seeking public input on novel provider-level quality measures prior to the implementation of the newly legislated Merit-Based Incentive Payment System (MIPS). Physician utilization rates of observation for localized prostate cancer (PCa) may serve as a meaningful quality measure, however, little is known about the degree of provider-level variation in the use of observation. METHODS: Using SEER-Medicare data, we studied men age 66 and older with localized PCa (2004-2009). Using mixed-effects
e282
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
direction toward reduction in over diagnosis and over treatment of clinically insignificant prostate cancer or stage migration toward more locally advanced disease due to lost opportunity in diagnosing and treating early clinically significant prostate cancer will remain to be seen.
Source of Funding: None
MP25-10 DECLINE IN PROSTATE SPECIFIC ANTIGEN SCREENING AMONG PRIMARY CARE PHYSICIANS IN RESPONSE TO UNITED STATES PREVENTATIVE SERVICES TASK FORCE RECOMMENDATIONS Jonathan Shoag, Khushabu Kasabwala*, Sameer Mittal, Joshua Halpern, Daniel Lee, Jim Hu, Christopher Barbieri, New York, NY INTRODUCTION AND OBJECTIVES: The United States Preventative Services Task Force (USPSTF) controversially recommended against prostate specific antigen (PSA) screening in its guideline released in October of 2011. Previous studies of national screening rates have found a significant decrease in PSA screening after the release of the USPSTF recommendations, however these are limited by their reliance on patient self report. The National Ambulatory Medical Care Survey (NAMCS) is a conducted annually by the Centers for Disease Control and Prevention (CDC), and collects data on PSA screening from records of medical visits. In this study, we aim to determine the frequency of PSA testing by primary care physicians before and after release of the USPSTF guidelines. METHODS: NAMCS is based on a sample of visits to nonfederal, office-based physicians. The basic sampling unit for the NAMCS is the physician-patient visit. All analysis was performed in accordance with NCHS recommendations accounting for the complex survey design, and Pearson0 s chi-squared test was used for all statistical comparisons. RESULTS: In men over forty seeing their primary care doctor for preventative care, the rate of PSA testing by year is shown in Figure 1. Comparing the years prior to the release of the USPSTF guideline and 2012, the rate of testing decreased from 28.3% (95% CI 25.2% to 31.5%) to 15.6% (95% CI 11.8% to 20.4%, p<0.001). The rate of testing by age is shown in Figure 2. The American Urological Association currently recommends joint decision-making in deciding on screening in men aged 55 to 69. The rate of screening among these men decreased from 33.0% (95% CI 29.4% to 36.8%) in 2002-2010 to 18.7% (95% CI 13.8% to 24.9%) in 2012 (p<0.001). CONCLUSIONS: Office-based prostate cancer screening decreased 45% after the release of the 2012 USPSTF guideline. This report, combined with results from other sources, suggest that the use of PSA screening is rapidly declining in primary care practice.
Source of Funding: None
MP25-11 PHYSICIAN-LEVEL VARIATION IN THE USE OF OBSERVATION FOR LOCALIZED PROSTATE CANCER Mark Tyson*, Amy Graves, Daniel Barocas, Sam Chang, David Penson, Matthew Resnick, Nashville, TN INTRODUCTION AND OBJECTIVES: The Center for Medicare & Medicaid Services is seeking public input on novel provider-level quality measures prior to the implementation of the newly legislated Merit-Based Incentive Payment System (MIPS). Physician utilization rates of observation for localized prostate cancer (PCa) may serve as a meaningful quality measure, however, little is known about the degree of provider-level variation in the use of observation. METHODS: Using SEER-Medicare data, we studied men age 66 and older with localized PCa (2004-2009). Using mixed-effects