Impact of an Electronic Health Record Maintenance Alert on PSA Screening Rates in a 10-Hospital Integrated Health System
Summary
\- The investigators propose a clinical trial to evaluate the impact of annual shared decision making for PSA screening, supported by system-level enhancements to promote evidence-based care: * Defined referral thresholds within the health maintenance reminder, aligned with clinical risk stratification per NCCN guidelines. * Enhanced clinical decision support (CDS) tools to reduce provider variation and ensure guideline-concordant screening and referral practices. * The goal is to reduce late-stage presentation without increasing overdiagnosis-ensuring that prostate cancer screening is both accessible and clinically effective.
Arms & interventions
- OtherAnnual PSA Health Maintenance Reminder
The annual health maintenance reminder does not mandate PSA screening for eligible patients. Instead, it recommends that primary care providers (PCPs) initiate a shared decision-making discussion with their patients. As part of this conversation, patients will be informed of their individual risk factors-including race, family history, and germline mutations-and can then make an informed choice about whether to proceed with PSA screening.
Outcome measures
Primary
Change in PSA screening completion rates in the BJC East Health System
The overall PSA screening rate will be calculated as the number of PSA screening tests that are ordered by PCPs who will receive the alert and completed by patients within a year of the ordering date, divided by the total number of eligible patients.
Time frame: Through 5 years
Secondary
Proportion of men diagnosed with clinically significant prostate cancer (Gleason score ≥ 7)
Time frame: Through 5 years
Incidence of advanced and metastatic disease at diagnosis of prostate cancer
Time frame: Through 5 years
Incidence of early-stage prostate cancer
Time frame: Through 5 years
Stage distribution of prostate cancer diagnoses
Time frame: Through 5 years
Biopsy rates
Time frame: Through 5 years
Percent of PSA screening ordered but not completed
Time frame: Through 5 years
Median PSA at time of diagnosis
Time frame: Through 5 years
Evaluate the agreement between 3T MRI and biomarker test results
Time frame: Through 5 years
PSA screening rate by age group
Time frame: Through 5 years
PSA screening rate by race
Time frame: Through 5 years
PSA screening rate by comorbidity burden
Time frame: Through 5 years
PSA screening rate by insurance coverage
Time frame: Through 5 years
PSA screening rate by provider
Time frame: Through 5 years
Eligibility criteria
Study locations (1)
Washington University School of Medicine
St Louis, Missouri, 63110