Outcomes Analysis: Decline observed in PSA-based screening for PCa

Christopher Saigal, MD, MPHStudies about ProPublica's Surgeon Scorecard, urology participation in accountable care organizations, and Twitter were among the take-home messages in outcomes analysis at the 2016 AUA annual meeting. The take-homes were presented by Christopher Saigal, MD, MPH, of the University of California, Los Angeles.

PSA-based screening for prostate cancer fell from 28.3% in 2002-2010 to 15.6% following the 2012 release of the U.S. Preventive Services Task Force’s grade “D” recommendation against PSA-based screening. Over the same period, screening decreased from 33.0% to 18.7% in men aged 55-69 years.

The ProPublica Surgeon Scorecard is a database containing information on radical prostatectomies and transurethral resections of the prostate performed by Medicare providers. Searching the database yields risk-adjusted readmission and mortality rates. The site has been accessed more than two million times, and although 90% of these visits may come from surgeons, such efforts will continue.

Comparing the Surgeon Scorecard with the Michigan Urological Surgical Improvement Collaborative (MUSIC) database, researchers found the scorecard had little correlation with important outcomes such as margin status. They also found little correlation with MUSIC-reported readmission rates and scorecard-reported readmission rates. Case volumes were also significantly undercounted.

Researchers found no relationship between Hospital Consumer Assessment of Healthcare Providers and Systems satisfaction scores and reported surgical or medical complications from major urologic surgeries. Nursing complications, however, such as bedsores and falls, did differ between patients in the highest and lowest terciles of patient satisfaction.

A review of the National Surgical Quality Improvement Program database found that gynecologists performed about three-fourths of sling surgeries and also had significantly higher risk-adjusted rates of infectious complications. Outcomes data such as these argue for further standardization of training in this field via combined female pelvic medicine/reconstructive surgery fellowships.

Continue to the next page for more take-home messages.

• Urology participation in accountable care organizations has been anemic. At least initially, only 10% of Medicare Shared Savings Program ACOs had urology participation. About half of ACOs had no urologists involved.

• Using time-driven activity-based cost accounting to redesign their approach for microhematuria workup, researchers were able to reduce their costs to deliver care by 15%. They also likely improved the patient experience through reduction in office visits.

• An analysis of data of men over age 40 years in the 2014 Behavior Risk Factor Surveillance System found that 58% reported hearing about the advantages of PSA screening, 28% reported hearing about the disadvantages, and 40% reported hearing about neither.

• In a group of patients interviewed after treatment counseling for small renal mass diagnosis, patients with high decisional conflict had lower disease-specific knowledge scores, less satisfaction with care, and lower perceived shared decision making. Approximately 20% of patients remained unsure about treatment choice after counseling.

• Distributing a decision aid as part of routine care for kidney stones is feasible, and the majority of patients using the aid reported that it helped them feel they were making a better decision and that they were more informed about risks and benefits, even though the majority preferred to follow the advice of a surgeon.

• A comparison of approaches to evaluation of asymptomatic microscopic hematuria found that a risk-stratification approach may minimize unnecessary workup and the harms and costs that can result from these workups.

• The number of tweets and Twitter participants discussing the AUA annual meeting has increased dramatically over the past 5 years. AUA-related tweets generated more than 23 million impressions in 2015, with an average of 116 tweets per hour during the meeting.

More from AUA 2016:

Kidney Ca: Cytoreductive nephrectomy appears to be protective

Prostate Ca: PSA drop, active surveillance are key themes

Stone Disease: New AUA guide discusses SWL vs. URS

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