Journal of the American Geriatrics Society
Julie Bynum, MD, MPH, Honor Passow, PhD, Donald Carmichael, MDiv, and Jonathan Skinner, PhD
Using PSA screening, we aimed to understand which factors influence practice change during a period when a decline in service use would be expected. First, we focused on national PSA screening in men aged 68 and older with fee-for-service Medicare from 2003 to 2013 and examine the influence of guidelines by assessing changes in likelihood of screening associated with factors directly mentioned in guidelines. Second, we focused on practice change across U.S. hospital referral regions (HRRs) for men aged 75 and older – for whom guidelines have been in agreement – to test whether practice variation declines and what contextual factors are associated with greater decline. We hypothesized that guidelines and the practice environment would influence the degree to which practitioners and patients would reduce their use of an existing practice in the face of converging evidence regarding effectiveness.