More Prostate Imaging Doesn’t Equal Better Care

Veterans with low-risk prostate cancer who use Medicare rather than the VA for healthcare could undergo more imaging without an improvement in the quality of care, according to a study published in the JAMA Network Open.

Researchers from New York, Seattle, and Connecticut sought to assess the association between prostate cancer imaging rates and the VA setting compared with the fee-for-service setting. A total of 98,867 men with prostate cancer (77.4 percent white; mean age, 70.26 years) participated in the study.

All men received a diagnosis of prostate cancer from Jan. 1, 2004, through March 31, 2008. The data were collected from the VA Central Cancer Registry, linked to administrate claims and Medicare utilization records, and the Surveillance, Epidemiology, and End Results Program database. Three distinct nationally representative cohorts were constructed (use of VA only, use of Medicare only, and dual use of VA and Medicare).

The study cohort comprised:

• Medicare-only: 57.3 percent
• VA and Medicare: 14.5 percent
• VA-only: 28.1 percent

Among men with low-risk prostate cancer, the Medicare-only group had the highest rate of guideline-discordant imaging:

• Medicare-only: 52.5 percent
• VA and Medicare: 50.9 percent
• VA-only: 45.9 percent

Imaging rates for men with high-risk prostate cancer were not significantly different among the three groups. Multivariable analysis showed that individuals in the VA and Medicare group and VA-only group (were less likely to receive guideline-discordant imaging than those in the Medicare-only group.

The researchers concluded that when men with low-risk prostate cancer sought care outside the VA, they used more health services but did not see an improvement in the quality of care.