MP62-02 ADHERENCE OF KAISER PERMANENTE SOUTHERN CALIFORNIA TO CHOOSING WISELY® INITIATIVE IN RADIOGRAPHIC IMAGING OF LOW RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-02 ADHERENCE OF KAISER PERMANENTE SOUTHERN CALIFORNIA TO CHOOSING WISELY® INITIATIVE IN RADIOGRAPHIC IMAGING OF LOW RISK PROSTATE CANCER Daniel Artenstein*, Tyler Kern, Aaron Krug, Joanie Chung, Steven Jacobsen, and Gary Chien Daniel Artenstein*Daniel Artenstein* More articles by this author , Tyler KernTyler Kern More articles by this author , Aaron KrugAaron Krug More articles by this author , Joanie ChungJoanie Chung More articles by this author , Steven JacobsenSteven Jacobsen More articles by this author , and Gary ChienGary Chien More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Choosing Wisely® is an initiative to avoid unnecessary medical workup and expenditure. In Urology, Statements 1 and 7 (published 2013 and 2015 respectively) state bone scans and abdominal CT scans are unnecessary in low risk prostate cancer (PCa). A SEER database study shows inappropriate imaging is ordered in 44% of patients with PCa. We evaluate the adherence of Kaiser Permanente Southern California (KPSC) physicians to these recommendations and whether the Choosing Wisely® changed the practice at KPSC. METHODS: We performed a retrospective study on patients diagnosed with low risk PCa (Gleason score < 7, PSA < 10) between January,1 2010-December 31, 2017 at KPSC. All demographics and imaging data were obtained. Statistical analysis was employed to compare the use of bone and CT scans in this population before and after these guidelines were published. RESULTS: Of a total of 7,793 patients who met our inclusion criteria, 3.6% and 9.7% of patients underwent a bone and CT scan, respectively. The percentage of these imaging studies with respect to year is shown in Figure 1. Using the Cochran-Armitage trend test we found that for both bone scan and CT scan there is a trend of decrease use between the time periods before and after the recommendations were published (p<0.0001). Using national average cost of bone scan ($1227) and CT ($928), this translates to cost of $1.05 million of inappropriate imaging at KPSC. On logistic regression analysis, for every point increase in PSA, there is a 17% and 8% increase in odds of having a bone scan and CT scan, respectively. When compared to whites, the odds of having a bone scan and CT scan are 51% and 24% lower for Asian, 30% and 12% lower for Black, and 34% and 4% lower for Hispanic patients, respectively. CONCLUSIONS: KPSC has a lower rate of inappropriate imaging for low risk PCa compared to published community rates. Choosing Wisely® decreased the rate of inappropriate imaging; however, the unnecessary imaging still cost KPSC more than $1 million. Higher PSA and white ethnicity are predictors for ordering inappropriate imaging. Current work is underway to identify reasons for inappropriate imaging, and to implement workflow to decrease even more rates. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e945-e945 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Artenstein* More articles by this author Tyler Kern More articles by this author Aaron Krug More articles by this author Joanie Chung More articles by this author Steven Jacobsen More articles by this author Gary Chien More articles by this author Expand All Advertisement PDF downloadLoading ...

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