Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool i
- PDF / 421,847 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 29 Downloads / 181 Views
Duke University, Durham, NC, USA; 2Cleveland Clinic, Cleveland, OH, USA; 3Maimonides Medical Center, New York, NY, USA; 4Weill Cornell Medical College, New York, NY, USA; 5SingHealth, Duke-NUS, Singapore, Singapore.
BACKGROUND: Implementation methods of riskstratified cancer screening guidance throughout a health care system remains understudied. OBJECTIVE: Conduct a preliminary analysis of the implementation of a risk-stratified prostate cancer screening algorithm in a single health care system. DESIGN: Comparison of men seen pre-implementation (2/1/2016–2/1/2017) vs. post-implementation (2/2/ 2017–2/21/2018). PARTICIPANTS: Men, aged 40–75 years, without a history of prostate cancer, who were seen by a primary care provider. INTERVENTIONS: The algorithm was integrated into two components in the electronic health record (EHR): in Health Maintenance as a personalized screening reminder and in tailored messages to providers that accompanied prostate-specific antigen (PSA) results. MAIN MEASURES: Primary outcomes: percent of men who met screening algorithm criteria; percent of men with a PSA result. Logistic repeated measures mixed models were used to test for differences in the proportion of individuals that met screening criteria in the pre- and postimplementation periods with age, race, family history, and PSA level included as covariates. KEY RESULTS: During the pre- and postimplementation periods, 49,053 and 49,980 men, respectively, were seen across 26 clinics (20.6% African American). The proportion of men who met screening algorithm criteria increased from 49.3% (pre-implementation) to 68.0% (post-implementation) (p < 0.001); this increase Previous Presentation 2019 Society of General Internal Medicine Annual Meeting Kevin C. Oeffinger and Kevin Shah are co-senior authors Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06124-2) contains supplementary material, which is available to authorized users. Received August 8, 2019 Accepted August 7, 2020
was observed across all races, age groups, and primary care clinics. Importantly, the percent of men who had a PSA did not change: 55.3% pre-implementation, 55.0% post-implementation. The adjusted odds of meeting algorithm-based screening was 6.5-times higher in the post-implementation period than in the preimplementation period (95% confidence interval, 5.97 to 7.05). CONCLUSIONS: In this preliminary analysis, following implementation of an EHR-based algorithm, we observed a rapid change in practice with an increase in screening in higher-risk groups balanced with a decrease in screening in low-risk groups. Future efforts will evaluate costs and downstream outcomes of this strategy. J Gen Intern Med DOI: 10.1007/s11606-020-06124-2 © Society of General Internal Medicine 2020
INTRODUCTION
Among men, prostate cancer is the most common non-skin cancer and the second most common cause of cancer-specific mortality.1, 2 Though prostate cancer is one of only five cancers in which randomized controlled trials (RCTs)
Data Loading...
