Table 2.
PSA Screening Rates in Men Aged 70+ with Limited Life Expectancy According to Medical Center and Patient Characteristics (N = 123,223)
| Characteristic | Screening PSA N (%) | Unadjusted Risk Ratio (95% CI) | Adjusted Risk Ratio* (95% CI) |
|---|---|---|---|
| VA Medical Center Characteristics | |||
| Census Region of VA Medical Center | |||
| West | 6922(39) | 1.0 | 1.0 |
| Midwest | 15411(43) | 1.07(0.93,1.22) | 1.15 (1.02,1.30) |
| Northeast | 8667(47) | 1.10(0.95,1.28) | 1.14(0.99,1.31) |
| South | 24828(49) | 1.15(1.02,1.30) | 1.25 (1.12,1.40) |
| Academic Affiliation | |||
| No | 19167(50) | 1.15(1.05–1.27) | 1.14(1.04–1.25) |
| Yes | 36661(43) | 1.0 | 1.0 |
| Incentives for Primary Care Performance | |||
| No | 23920(43) | 1.0 | 1.0 |
| Yes | 30266(48) | 1.15(1.05,1.27) | 1.06(0.98,1.15) |
| Primary Care Initial Appt Length ≥45 min | |||
| No | 40871(45) | 1.0 | 1.0 |
| Yes | 13315(46) | 0.95(0.85,1.07) | 0.98(0.89,1.09) |
| Primary Care Geriatricians | |||
| No | 23990(46) | 1.0 | 1.0 |
| Yes | 29831(45) | 1.06(0.96,1.16) | 0.94(0.86,1.03) |
| VA Size (number of men in cohort) | |||
| Lowest Tertile (≤3,995 men) | 8945(46) | 1.0 | 1.0 |
| Middle Tertile (3,995–5,872 men) | 32375(46) | 0.93(0.83,1.04) | 0.98(0.88,1.10) |
| Highest Tertile (≥5,872 men) | 14508(43) | 0.97(0.87,1.09) | 1.00(0.88,1.15) |
| Performance on Prostate Cancer Education | |||
| >90% | 27194(45) | 1.0 | 1.0 |
| ≤90% | 28634(46) | 0.97(0.88,1.07) | 1.00(0.91,1.08) |
| Performance on Colorectal Cancer Screening | |||
| >67% | 29497(45) | 1.0 | 1.0 |
| ≤67% | 26331(46) | 1.02(0.93,1.12) | 0.95(0.87,1.05) |
| Number of Outpatient Visits in 2002 | |||
| Lowest Tertile (≤201,864 visits) | 10864 (46) | 1.0 | 1.0 |
| Middle Tertile (201,864–365,000 visits) | 18260 (43) | 0.97(0.84–1.10) | 1.00(0.87–1.16) |
| Highest Tertile (>365,000 visits) | 26704 (47) | 1.01(0.88–1.14) | 1.20(0.97–1.47) |
| Total Health Care Expenditures in 2002 | |||
| Lowest Tertile (≤$88,687,612) | 10762 (47) | 1.0 | 1.0 |
| Middle Tertile ($88,687,612–$177,724,499) | 17217 (44) | 0.95(0.82–1.07) | 0.92(0.79–1.06) |
| Highest Tertile (>$177,724,499) | 27849 (45) | 0.96(0.84–1.09) | 0.82(0.66–1.02) |
| Ratio of NP or PAs to MDs | |||
| <3:4 | 43514 (45) | 1.0 | 1.0 |
| ≥3:4 | 6176 (55) | 1.18(1.02–1.35) | 1.20(1.09–1.32) |
| Patient Characteristics | |||
| Age, years | |||
| 70–74 | 18224(55) | 1.0 | 1.0 |
| 75–79 | 18387(48) | 0.87(0.85,0.89) | 0.87(0.85,0.89) |
| 80–84 | 9745(40) | 0.72(0.70,0.73) | 0.71(0.70,0.73) |
| ≥85 | 9472(34) | 0.62(0.61,0.64) | 0.62(0.61,0.64) |
| Race/Ethnicity | |||
| White | 51028(46) | 1.0 | 1.0 |
| Black | 3288(37) | 0.82(0.79,0.85) | 0.79(0.76,0.82) |
| White Hispanic | 987(47) | 0.86(0.80,0.92) | 0.88(0.82,0.94) |
| Other | 525(35) | 0.81(0.74,0.88) | 0.83(0.76,0.90) |
| Married | |||
| No | 14720(40) | 1.0 | 1.0 |
| Yes | 40742(48) | 1.18(1.16,1.21) | 1.13(1.11,1.16) |
| Lived in ZCTA in which ≥25% of Adults Had a College Education | |||
| No | 36680(45) | 1.0 | 1.0 |
| Yes | 17878(47) | 1.04(1.02,1.05) | 1.06(1.03,1.08) |
| Median Income of ZCTA | |||
| Highest Tertile (≥41,943) | 18788(46) | 1.0 | 1.0 |
| Middle Tertile (32,980,41,943) | 17990(45) | 0.98(0.96,1.00) | 1.00(0.98,1.03) |
| Lowest Tertile (≤32,980) | 17788(45) | 0.94(0.92,0.96) | 0.99(0.96,1.02) |
*Adjusted for all characteristics in Table 2