There has been an increasing focus on improving value in health care and deimplementing the use of low-value services, such as prostate cancer (PC) screening for men aged >70 years. The objectives of this study are to (1) identify the proportion of primary care visits at which low-value PC screening is ordered, and (2) identify predisposing, enabling, and health care need characteristics associated with low-value PC screening in the United States. METHODS: This was a secondary analysis of the National Ambulatory Medicare Care Survey datasets from 2013 to 2016 and 2018. Andersen's Behavioral Model of Health Services Use guided independent variable selection. Weighted multivariable logit models were used to analyze data. RESULTS: There were 6.71 low-value prostate-specific antigens (PSAs) per 100 visits and 1.65 low-value digital rectal exams (DREs) per 100 visits. For each additional service ordered by primary care providers, the odds of ordering a low-value PSA increased by 49%, and the odds of performing a low-value DRE increased by 37%. CONCLUSIONS: The use of low-value PSAs and DREs was sizable during the observed time period. Organizations who want to reduce low-value PSAs and DREs may want to focus interventions on providers who order a high number of tests.
Journal of the American Board of Family Medicine : JABFM. 2023 Jan 02 [Epub ahead of print]
Chris Gillette, Sarah Garvick, Nathan Bates, Courtney M Martin, Amresh Hanchate, Daniel S Reuland
From Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC (CG, SG, NB, CMM); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (CG); Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (AH); General Medicine, University of North Carolina School of Medicine, Chapel Hill (DSR). ., From Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC (CG, SG, NB, CMM); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (CG); Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (AH); General Medicine, University of North Carolina School of Medicine, Chapel Hill (DSR).