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BACKGROUND/RATIONALE:
Timely follow up of suspicious screening tests for cancers other than prostate has been identified as an important priority in the VA. There remains considerably uncertainty regarding PSA screening, with recent studies finding inappropriate use of PSA in the VA. Identifying how to appropriately manage the results of abnormal PSA results in the VA is of growing importance due to the seemingly haphazard use of the test in practice.
OBJECTIVE(S):
This study will evaluate quality of care for abnormal PSA results using electronic data and validate our findings with medical records abstraction. The goal is to develop measures of quality that can be evaluated broadly in the VA in order to reduce inappropriate or poor quality care.
Aim 1. Measure completeness and timeliness in follow up care among men in VISN20 with suspicious PSA levels, including timeliness and receipt of biopsy.
Aim 2. Validate database measures of follow up care and identify potential barriers to care through a medical record abstraction audit of 160 patients with suspected gaps in follow up.
METHODS:
Using the VISN20 data warehouse we will identify approximately 14,000 veterans who have received an abnormal PSA test and extract data regarding the care they received following that abnormal result. Patients will be classified into 4 mutually exclusive categories: 1) any follow up care that does not include biopsy, 2) follow up care includes a biopsy, 3) referred for care but care was not received within VA, 4) no follow-up care. A random sample of records will be abstracted from each of these 4 categories. Descriptive analyses of the frequency of these care pathways will be conducted and will be compared to abstracted records. We will examine the frequency of potentially delayed diagnosis of prostate cancer operationally defined as diagnosis >1 year following the abnormal PSA test. If this outcome is common, we will examine potential risk factors for delayed diagnosis, including structural barriers such as limited access to specialty urology care.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
This project will assess potential gaps in the quality of care veterans receive related to follow up of abnormal prostate cancer screening tests and identify the sources of those gaps so that care pathways can be modified to eliminate poor quality care.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Prevention, Resource Use and Cost
Keywords:
Cancer, Prostate disease, Screening
MeSH Terms:
none
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