Table 2.
Adjusted Odds Ratios (OR) for patient and provider factors associated with PSA order
| All Encounters | Low-Value | Appropriate | |||||
|---|---|---|---|---|---|---|---|
| PSA Not Ordered |
PSA Ordered |
OR (CI) | P- Value1 |
OR (CI) | OR (CI) | P- Value2 |
|
| Patient Factors | |||||||
| CCI | |||||||
| 0 | 801,078 (97.6%) | 19,928 (2.4%) | 1 | <0.001 | 1 | 1 | <0.001 |
| 1 | 278,762 (97.1%) | 8,281 (2.9%) | 0.8 (0.73, 0.80) | 0.9 (0.81, 0.96) | 0.8 (0.77, 0.84) | ||
| 2 | 169,373 (97.2%) | 4,848 (2.8%) | 0.7 (0.65, 0.73) | 0.3 (0.26, 0.33) | 0.7 (0.68, 0.77) | ||
| 3+ | 446,526 (98.0%) | 9,225 (2.0%) | 0.5 (0.46, 0.50) | 0.0 (0.04, 0.05) | 0.6 (0.54, 0.66) | ||
| Family hx of prostate ca | |||||||
| No | 1,625,904 (97.7%) | 38,097 (2.3%) | 1 | <0.001 | 1 | 1 | 0.01 |
| Yes | 69,835 (94.3%) | 4,185 (5.7%) | 1.8 (1.73, 1.96) | 1.6 (1.40, 1.73) | 2.2 (2.03, 2.37) | ||
| Family hx of BROCA | |||||||
| No | 1,613,361 (97.6%) | 39,395 (2.4%) | 1 | 0.04 | 1 | 1 | 0.26 |
| Yes | 82,378 (96.6%) | 2,887 (3.4%) | 1.2 (1.11, 1.27) | 1.1 (1.00, 1.24) | 1.3 (1.18, 1.40) | ||
| Race/Ethnicity | |||||||
| White | 1,339,135 (97.5%) | 34,918 (2.5%) | 1 | <0.001 | 1 | 1 | <0.001 |
| African | 33,569 (98.1%) | 666 (1.9%) | 0.8 (0.68, 0.92) | 0.7 (0.59, 0.92) | 0.8 (0.64, 0.99) | ||
| Asian | 39,881 (97.5%) | 1,014 (2.5%) | 1.0 (0.94, 1.17) | 0.8 (0.71, 0.98) | 1.2 (1.06, 1.39) | ||
| Hispanic | 155,591 (98.1%) | 3,088 (1.9%) | 0.8 (0.80, 0.90) | 0.8 (0.71, 0.85) | 1.0 (0.92, 1.06) | ||
| Other | 74,593 (98.0%) | 1,520 (2.0%) | 0.8 (0.72, 0.86) | 0.8 (0.69, 0.93) | 0.8 (0.74, 0.92) | ||
| Unknown | 52,970 (98.0%) | 1,076 (2.0%) | 0.6 (0.53, 0.67) | 0.7 (0.57, 0.80) | 0.6 (0.49, 0.64) | ||
| Prior PSA test value | |||||||
| [<1] | 146,928 (93.3%) | 10,566 (6.7%) | 1 | <0.001 | 1 | 1 | <0.001 |
| (1,2] | 73,444 (93.4%) | 5,170 (6.6%) | 0.9 (0.80, 0.94) | 0.8 (0.71, 0.88) | 1.2 (1.00, 1.39) | ||
| (2,3] | 31,755 (93.4%) | 2,260 (6.6%) | 0.9 (0.81, 1.01) | 0.8 (0.65, 0.87) | 1.3 (1.08, 1.68) | ||
| (3,6] | 30,286 (90.3%) | 3,249 (9.7%) | 1.3 (1.17, 1.46) | 1.0 (0.84, 1.12) | 2.0 (1.53, 2.51) | ||
| (6+) | 10,312 (80.6%) | 2,475 (19.4%) | 2.6 (2.26, 3.11) | 2.2 (1.84, 2.76) | 3.1 (2.12, 4.66) | ||
| No prior test | 1,403,014 (98.7%) | 18,562 (1.3%) | 0.7 (0.62, 0.71) | 0.2 (0.22, 0.27) | 2.3 (1.98, 2.68) | ||
| Provider Factors | |||||||
| Gender | |||||||
| M | 1,133,143 (97.4%) | 30,110 (2.6%) | 1 | 0.02 | 1 | 1 | <0.001 |
| F | 562,596 (97.9%) | 12,172 (2.1%) | 0.8 (0.81, 0.86) | 1.0 (0.91, 1.00) | 0.8 (0.73, 0.80) | ||
| Primary specialty | |||||||
| APP | 237,479 (98.2%) | 4,317 (1.8%) | 1 | <0.001 | 1 | 1 | <0.001 |
| Fam. Medicine | 150,211 (97.7%) | 3,564 (2.3%) | 1.3 (1.20, 1.32) | 1.0 (0.96, 1.11) | 1.5 (1.39, 1.56) | ||
| Gen. Surgery | 1,636 (97.1%) | 49 (2.9%) | 0.9 (0.66, 1.18) | 1.0 (0.70, 1.44) | 0.6 (0.39, 1.05) | ||
| Int. Medicine | 104,155 (95.5%) | 4,897 (4.5%) | 1.7 (1.65, 1.81) | 1.3 (1.25, 1.42) | 2.2 (2.05, 2.32) | ||
| Med. Sub. | 321,138 (99.0%) | 3,334 (1.0%) | 0.3 (0.32, 0.36) | 0.4 (0.39, 0.45) | 0.3 (0.28, 0.33) | ||
| Surg. Sub. | 117,651 (99.4%) | 684 (0.6%) | 0.2 (0.17, 0.20) | 0.2 (0.22, 0.28) | 0.2 (0.15, 0.18) | ||
| Urology | 18,285 (92.6%) | 1,467 (7.4%) | 1.9 (1.73, 2.08) | 2.3 (2.03, 2.63) | 1.8 (1.58, 2.02) | ||
| Other | 129,610 (99.5%) | 702 (0.5%) | 0.3 (0.31, 0.36) | 0.3 (0.28, 0.36) | 0.4 (0.36, 0.44) | ||
| Graduation year | |||||||
| <1980 | 111,478 (97.7%) | 2,621 (2.3%) | 1 | <0.001 | 1 | 1 | <0.001 |
| 1980’s | 284,985 (96.4%) | 10,594 (3.6%) | 1.0 (0.96, 1.12) | 0.9 (0.77, 0.96) | 1.2 (1.07, 1.30) | ||
| 1990’s | 292,762 (96.6%) | 10,386 (3.4%) | 1.0 (0.94, 1.11) | 0.8 (0.75, 0.93) | 1.2 (1.10, 1.34) | ||
| 2000’s | 613,949 (98.0%) | 12,847 (2.0%) | 0.7 (0.64, 0.75) | 0.6 (0.55, 0.68) | 0.8 (0.71, 0.86) | ||
| Missing | 201,268 (98.1%) | 3,807 (1.9%) | 0.7 (0.64, 0.76) | 0.7 (0.60, 0.76) | 0.7 (0.66, 0.82) | ||
| Provider’s school rank | |||||||
| Rank 1-42 | 558,026 (97.2%) | 16,129 (2.8%) | 1 | <0.001 | 1 | 1 | <0.001 |
| Rank 43-83 | 213,038 (97.0%) | 6,638 (3.0%) | 1.0 (0.93, 1.02) | 0.8 (0.79, 0.90) | 1.1 (1.00, 1.12) | ||
| Unranked | 738,564 (97.7%) | 17,563 (2.3%) | 0.9 (0.88, 0.94) | 0.9 (0.82, 0.92) | 1.0 (0.93, 1.02) | ||
| Missing | 186,111 (99.0%) | 1,952 (1.0%) | 2.0 (1.30, 3.00) | 1.3 (0.73, 2.16) | 2.8 (1.62, 4.83) | ||
1.
P-values are for whether the factor is significantly associated with PSA testing.
2.
P-values are for interactions between the named factor and appropriate versus low-value testing.
3.
BROCA: Breast or Ovarian cancer; APP- Advanced Practice Provider