Reducing Inappropriate Use of PSA Screening for Prostate Cancer: a Population Health Case Study

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Overview

Clinical Informatics, Data Analytics, and Population Health Methodologies Lead to Significant Reduction in the Clinically Inappropriate Use of PSA-Based Screening for Prostate Cancer

 

Challenge

In November of 2019, a systematic review of data obtained from the electronic health records (EHR) of veterans seen at Valor outpatient clinics, it was noted that many of our medical providers (physicians, physician assistants, and nurse practitioners) were routinely ordering PSA screening blood tests in a fashion inconsistent with national clinical practice guidelines and USPSTF recommendations.  Specifically, for men 70 years and older, Valor Healthcare providers were (in aggregate) unnecessarily screening for prostate cancer using the PSA blood test 31.8% of the time. In contrast, for veterans enrolled in VA healthcare across the country, the rate was 30%.

Following the Plan-Do-Study-Act (PDSA) model for process improvement, Valor Healthcare initiated a plan to identify reasons for the inappropriate ordering as well as a multi-faceted approach to improvement.  We found that the reasons for inappropriate ordering of PSA screening in men 70 years and older fell into three broad categories:

  1. Basic knowledge deficit in our veteran patients, community medical providers and clinical staff.
  2. A lack of clear, consistent, and company-wide clinic-level process to identify PSA blood tests for whom the test is not recommended.
  3. Bias among the staff to adhere to the patient’s wishes, regardless of whether or not the test was clinically indicated to improve the veteran’s perceived patient experience.

Solution

Once the factors contributing to the inordinately high percentage of men 70 and older having a PSA drawn were identified and contributing factors were assessed, an actionable process improvement plan was designed.  Data sets were reported on a monthly basis, which allowed for close and rapid follow up with staff to ensure compliance with the improvement plan and overall improvement of the metric nationwide.

Outcome

The study found that clinical quality scores are 25% higher in physician-run organizations When a physician leads a healthcare organization, it signals they have “walked the walk” and the organizations they lead are focused on the most important value – the needs of the patient come first. Our organization is keenly focused on delivering evidence-based, outcomes-proven, best-in-industry healthcare for the federal government and its many serving patriots.