Appropriateness of Prostate Cancer Imaging among Veterans in a Delivery System without Incentives for Overutilization.

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.

Health services research. 2015 Sep 30 [Epub ahead of print]

Danil V Makarov, Elaine Y C Hu, Dawn Walter, R Scott Braithwaite, Scott Sherman, Heather T Gold, Xiao-Hua Andrew Zhou, Cary P Gross, Steven B Zeliadt

VA New York Harbor Healthcare System, New York University, New York, NY. , VA Puget Sound Healthcare System and University of Washington, Seattle, WA. , VA New York Harbor Healthcare System, New York University, New York, NY. , Department of Population Health, New York University, New York, NY. , VA New York Harbor Healthcare System, New York University, New York, NY. , Department of Population Health, New York University, New York, NY. , VA Puget Sound Healthcare System and University of Washington, Seattle, WA. , Robert Wood Johnson Clinical Scholars Program and Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. , VA Puget Sound Healthcare System and University of Washington, Seattle, WA.

PubMed

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