Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network.
J Gen Intern Med
; 36(1): 92-99, 2021 01.
Article
en En
| MEDLINE
| ID: mdl-32875501
ABSTRACT
BACKGROUND:
Implementation methods of risk-stratified 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. MAINMEASURES:
Primaryoutcomes:
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 post-implementation periods with age, race, family history, and PSA level included as covariates. KEYRESULTS:
During the pre- and post-implementation 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 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 pre-implementation 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.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Neoplasias de la Próstata
/
Sistemas de Apoyo a Decisiones Clínicas
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Guideline
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Límite:
Adult
/
Aged
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Gen Intern Med
Asunto de la revista:
MEDICINA INTERNA
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos