Abstract:
BACKGROUND:Most guidelines recommend against PSA-based screening for prostate cancer in men ≥ 70 years of age. Adherence to these guidelines is variable. OBJECTIVE:To determine whether the use of a "Best Practice Advisory" (BPA) intervention within the electronic medical record (EMR) system can alter the rate of PSA screening in men ≥ 70 years of age. DESIGN:This is an interventional study spanning the years 2013 through 2017, in men ≥ 70 years of age in Kaiser Permanente Northern California with no prior history of prostate cancer. The BPA intervention was activated in the EMR system on October 15, 2015, with no prior notice or education. SETTING:Integrated healthcare system including all Kaiser Permanente Northern California facilities. PARTICIPANTS:A population-based sample that included all male members ≥ 70 years of age without a history of prostate cancer. MAIN MEASURES:The main outcome was the rate of PSA testing in men ≥ 70 years of age. We compared the rates of PSA testing between the pre-BPA period (January 1, 2013-October 14, 2015) and the post-BPA period (October 15, 2015-December 31, 2017). An interrupted time series analysis of PSA ordering rates was performed. KEY RESULTS:Following the 2015 BPA intervention, screening rates substantially declined from 36.0 per 100 person-years to 14.9 per 100 person-years (rate ratio = 0.415; 95% CI: 0.410-0.419). The effect of the BPA was comparable among all patient races and ordering provider specialties. The interrupted time series analysis showed a rapid, large, and sustained drop in the rate of PSA ordering, and much less temporal variation in test ordering after activation of the BPA. CONCLUSION:Following activation of a BPA within the EMR, the rates of inappropriate PSA testing significantly declined by 58.5% in men ≥ 70 years of age and temporal variation was reduced.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Presti J Jr,Alexeeff S,Horton B,Prausnitz S,Avins ALdoi
10.1007/s11606-020-06097-2subject
Has Abstractpub_date
2020-11-01 00:00:00pages
796-801issue
Suppl 2eissn
0884-8734issn
1525-1497pii
10.1007/s11606-020-06097-2journal_volume
35pub_type
杂志文章abstract:OBJECTIVE:Heart failure (HF) is a leading cause of hospitalization. Clinical and socio-demographic factors have been associated with cardiac admissions, but little is known about the role of anxiety. We examined whether symptoms of anxiety were associated with cardiac hospitalizations at 12 months in HF patients. METH...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-011-1843-1
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:To determine the impact of prospective payment by diagnosis-related groups (DRGs) on length of stay in the hospital, ambulatory status, and level of post-hospital care needed for patients hospitalized with hip fracture. DESIGN:Retrospective chart review of a consecutive series of cases before and after the r...
journal_title:Journal of general internal medicine
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更新日期:1989-09-01 00:00:00
abstract:BACKGROUND:Heterogeneity of existing physician burnout studies impairs analyses of longitudinal trends, geographic distribution, and organizational factors impacting physician burnout. The Department of Veterans Affairs (VA) is one of the largest integrated healthcare systems in the USA, offering a unique opportunity t...
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更新日期:2020-05-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-017-3987-0
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Changes to national guidelines for breast and cervical cancer screening have created confusion and controversy for women and their primary care providers. OBJECTIVE:To characterize women's primary health care provider attitudes towards screening and changes in practice in response to recent revisions in gui...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-015-3449-5
更新日期:2016-01-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2004-08-01 00:00:00
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journal_title:Journal of general internal medicine
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doi:10.1111/j.1525-1497.2005.0123.x
更新日期:2005-07-01 00:00:00
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journal_title:Journal of general internal medicine
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doi:10.1007/s11606-010-1542-3
更新日期:2011-04-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:1999-01-01 00:00:00
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更新日期:2007-11-01 00:00:00
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journal_title:Journal of general internal medicine
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doi:10.1111/j.1525-1497.2001.00214.x
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更新日期:2011-08-01 00:00:00
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更新日期:2019-03-01 00:00:00
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journal_title:Journal of general internal medicine
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doi:10.1007/BF02598281
更新日期:1993-12-01 00:00:00
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更新日期:2020-12-01 00:00:00
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更新日期:1991-07-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1318-9
更新日期:2010-07-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
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更新日期:2011-03-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2005-07-01 00:00:00
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更新日期:2007-07-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
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更新日期:2006-02-01 00:00:00
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更新日期:2010-08-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2013-02-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2005-01-01 00:00:00
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更新日期:2019-06-01 00:00:00
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更新日期:2020-07-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2020-12-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2007-10-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2008-08-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2001-03-01 00:00:00