2064 A REMINDER ORDER CHECK TO REDUCE PROSTATE CANCER SCREENING IN ELDERLY VETERANS

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening (IV)1 Apr 20132064 A REMINDER ORDER CHECK TO REDUCE PROSTATE CANCER SCREENING IN ELDERLY VETERANS Jeremy Shelton, Carol Bennett, Lee Ochotorena, and Caroline Goldzweig Jeremy SheltonJeremy Shelton Los Angeles, CA More articles by this author , Carol BennettCarol Bennett Los Angeles, CA More articles by this author , Lee OchotorenaLee Ochotorena Los Angeles, CA More articles by this author , and Caroline GoldzweigCaroline Goldzweig Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2483AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While there is much debate about the value and appropriate use of PSA-based screening for prostate cancer, the Veterans Health Administration's national clinical policy is to use age as a proxy for life expectancy and avoid screening in men over the age of 74. To facilitate this we developed and implemented a highly specific computerized clinical decision support (CCDS) reminder to identify PSA blood tests ordered to screen for prostate cancer, and to remind providers, at the moment of entering the order, of the current guidelines. We chose a highly specific definition of screening-PSA to reduce “alert fatigue.” METHODS We defined PSA for screening as follows: any PSA ordered on men excluding those a) with a related diagnosis of existing malignant or benign prostate disease, b) with a diagnosis of “elevated prostate specific antigen”, c) who are using either enhancers or suppressors of testosterone, or d) who had a PSA of 2.5ng/ml or greater on either of the two most recent PSA tests at GLA (if applicable). A provider ordering a PSA on any patient meeting the above criteria would be presented with an alert with the following text, “The US Preventive Services Task Force and VHA recommend AGAINST screening for prostate cancer in men 75 or older because the harms outweigh the benefits. Reconsider if this is a screening PSA.” We measured PSA-based prostate cancer screening rates monthly from 10/2011 to 10/2012. From 5/2012-9/2012 we turned on the CCDS reminder. RESULTS The mean screening rate during the 12 month study period was 6.7% among men age 75 and older. Out of a monthly average of 3500 unique patients seeking healthcare and aged 75 or older, a mean of 128 were screened monthly. The mean screening rate during the first 4 months of the study period was 7.7% and during the four months when the CCDS tool was active, it was 5.4%, reflecting a 30% reduction in screening rate. CONCLUSIONS The mean PSA-based prostate cancer screening rate at the GLA VA during the 12 months of this study period was low compared to prior reports over the last decade of screening rates both within and without the VA. Given the significant media coverage of the US Preventive Services Task Force recommendations during 2012, it is not possible at this time to attribute the observed reduction in screening rate to the CCDS intervention. Further work is needed to see if the CCDS tool can play a role in facilitating the VA?s goal of further reducing PSA screening in men aged 75 and older. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e847-e848 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeremy Shelton Los Angeles, CA More articles by this author Carol Bennett Los Angeles, CA More articles by this author Lee Ochotorena Los Angeles, CA More articles by this author Caroline Goldzweig Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...