Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort study

Table 2 Outcomes for prostate cancer care in patients by PCPs with a high or low PSA ordering rate

Outcomes Test/Treatment/Service type	N (%)		Odds Ratio (95 % CI), High vs. Low
Outcomes Test/Treatment/Service type	High (N = 22853)	Low (N = 23929)	Odds Ratio (95 % CI), High vs. Low
Diagnostic Test
PSA test	18889 (82.7)	13808 (57.7)	3.64 (3.48, 3.80)
Biopsy	546 (2.4)	497 (2.1)	1.16 (1.02, 1.31)
Ultrasound	774 (3.4)	688 (2.9)	1.19 (1.07, 1.32)
Imaging	196 (0.9)	174 (0.7)	1.18 (0.96, 1.45)
Treatment
Any treatment for prostate cancer	270 (1.2)	258 (1.1)	1.10 (0.93, 1.31)
Radiation	159 (0.7)	124 (0.5)	1.31 (1.03, 1.66)
Radical prostatectomy	18 (0.1)	30 (0.1)	0.67 (0.37, 1.21)
Androgen deprivation therapy	166 (0.7)	162 (0.7)	1.11 (0.89, 1.38)
Health Services
Outpatient office visit for prostate cancer	413 (1.8)	365 (1.5)	1.21 (1.05, 1.39)
Outpatient office visit to urologists	8087 (35.4)	8434 (35.2)	0.98 (0.94, 1.02)
Without any prostate cancer associated utilization listed above	3915 (17.1)	10046 (42.0)	0.27 (0.26, 0.29)

The average adjusted rate of ordering PSA test in 550 high test rate PCPs in 2009 was 63.0 ± 10.4. The average adjusted rate of ordering PSA test in 638 low test rate PCPs in 2009 was 7.6 ± 5.2. The odds ratio was estimated by logistic models adjusted for age, ethnicity, comorbidity, Medicaid eligibility, urban or rural residence and education at the zip code level. 80 (0.17 %) men with unknown urban/rural residence or education information were excluded. Prostate cancer associated utilization did not include outpatient office visits to urologists as the reason for the visit was not limited to prostate cancer
CI confidence interval, PCP primary care provider, PSA prostate specific antigen

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