Use of an electronic health record to improve follow-up of elevated lab results: The PSA safety net.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 292-292
Author(s):  
Kim N. Danforth ◽  
Steven J. Jacobsen ◽  
Lauren N. Miyaguchi ◽  
Hui Zhou ◽  
Jeff M. Slezak ◽  
...  

292 Background: Follow-up of laboratory results is challenging in outpatient care, and research indicates an electronic health record (EHR) alone is insufficient to ensure appropriate follow-up of abnormal results. Methods: In April 2006, Kaiser Permanente Southern California implemented a Prostate-Specific Antigen (PSA) Safety Net to detect men with elevated serum PSA levels who had not yet received follow-up care at 6 months post-testing. The PSA Safety Net scanned the EHR to identify men age 45-79 with elevated PSA values. Men were then excluded if they had a prior prostate cancer diagnosis or evidence of follow-up care within 6 months of the PSA test, defined as any of the following: a subsequent visit with a urologist or oncologist, normal PSA value, biopsy, or prostate cancer diagnosis. In June 2009, the criterion for follow-up care was reduced from 6 to 3 months. The electronic Safety Net tool was refreshed daily, stored key data (e.g., contact information), and recorded actions of care managers (e.g., expedited appointment scheduled). We evaluated how many men were identified through the PSA Safety Net and whether they were systematically different from men followed through routine care. Results: From 4/2006-12/2010, 45,762 men had an elevated serum PSA level. Twenty percent (n=9,373) were identified through the PSA Safety Net. Of 7,729 prostate cancers diagnosed, 9.6% (n=739) were found through the PSA Safety Net. Age, race/ethnicity, and language preference was similar among men followed through the Safety Net vs. routine care. Men followed through the PSA Safety Net were less likely to be enrolled in kp.org (46% vs. 54% respectively, p<0.001), which provides online access to lab results. Median PSA levels were slightly lower among those followed through the PSA Safety Net. Men in the Safety Net also were less likely to be diagnosed with Stage IV cancers than men followed via routine care (2.8% vs. 5.5%, p=0.002), although stage was similar overall. Conclusions: Within a health system using an advanced EHR, a substantial number of men with elevated PSA levels were identified and managed through a PSA Safety Net. These men were largely similar to those followed through routine care, although tended toward lower risk.

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2652-2652
Author(s):  
Sudipto Mukherjee ◽  
Chandana A. Reddy ◽  
Jay P. Ciezki ◽  
Ramon V. Tiu ◽  
Anjali S. Advani ◽  
...  

Abstract Background Prostate cancer is the most common cancer diagnosis in men, and one of the leading indications for radiation therapy. The risk of resultant secondary leukemias has not been consistently established. We investigated the risk of all leukemias in a population-based cohort of patients (pts) with locoregional prostate cancer definitively treated with radiotherapy. Methods We queried the Surveillance, Epidemiology, and End Results (SEER) 17 registries to identify a cohort of men >20 years old (n = 183,268) with locoregional prostate adenocarcinoma newly diagnosed between January 1973 and December 2008. Pts who underwent initial treatment with radical prostatectomy (RP) were compared to pts receiving RP with external beam radiotherapy (RP w/EBRT) to investigate the risk of radiation-induced leukemias. These cohorts tend to be well matched regarding age, medical comorbidities and disease characteristics. All new leukemias occurring as a second primary cancer at least one year after the first diagnosis of prostate cancer were identified in SEER using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) morphology codes. Secondary leukemias included acute myeloid leukemia (AML); chronic myelogenous leukemia (CML); acute and chronic lymphocytic leukemia (ALL & CLL) and other categories as reported in SEER. Pts were observed from date of prostate cancer diagnosis until leukemia occurrence, death, or last date of follow-up. Univariate and multivariate analyses were performed using the Fine and Gray competing risk regression analysis with leukemia as a time-dependent endpoint and death from any cause or the diagnosis of any other second cancer as competing events. RP w/ EBRT group was compared with the RP cohort as the reference group, controlling for age. Hazard ratios (HR) with 95% confidence intervals (CIs) are reported. Results Median age was 67 years (yrs, range 22 – 105) at prostate cancer diagnosis: 67 yrs in RP and 68 yrs in RP w/ EBRT pts (p<0.0001); 158,913 (86.7%) were treated with RP and 24,355 (13.3%) with RP w/EBRT. Median follow-up was 7.6 yrs [(range, 1 – 35.5): 7.5 yrs in the RP group and 8.3 yrs in the RP w/ EBRT group, (p<0.0001)]. In total, 949 (0.5%) leukemia cases were identified: 336 (0.2%) acute leukemias [266 (0.2%) in the RP group and 70 (0.3%) in the RP w/ EBRT]; 538 (0.3%) chronic leukemias [462 (0.3%) in the RP group and 76 (0.3%) in the RP w/ EBRT] and 75 (0.04%) of unspecified histology. Histologic subtypes (per ICD-O-3 codes) were: AML (n=249), acute monocytic leukemia (n=18), ALL (n=24), other acute leukemias (n=45), other myeloid/monocytic/lymphocytic leukemias (n=48), aleukemic/subleukemic/NOS (n=27), CML (n=131) and CLL (n=407). Median age at acute leukemia diagnosis was 77 yrs [(range, 50 – 101): 78 yrs in the RP group and 76 yrs in RP w/EBRT pts, (p=0.0271)] and for chronic leukemias was 76 yrs [(range, 47 – 101): 76 yrs in the RP group and 77 yrs in the RP w/EBRT pts, (p=0.50)].The median time to develop acute leukemias was 6.0 yrs [(range, 1 – 28.2): 6.1 yrs in the RP group and 5.7 yrs in the RP w/EBRT pts, (p=0.20)] and chronic leukemias was 6.9 yrs [(range, 1 – 29.8): 6.7 yrs in the RP group and 8.6 yrs in the RP w/EBRT pts, (p=0.0020)]. The cumulative incidence rate (CIR) at 20 years for acute leukemias was 0.24% for the RP pts vs. 0.32% for the RP w/EBRT pts (p=0.0196). The CIR at 20 years for chronic leukemias was 0.47% for the RP pts vs. 0.36% for the RP w/EBRT pts (p=0.10). In univariate analyses, age >70 yrs (HR=1.40; CI, 1.13 – 1.74; p=0.0023), and those who received RP w/ EBRT (HR=1.49; CI, 1.14 – 1.94; p=0.0033) were significantly more likely to develop acute leukemias. In multivariate analysis, both advanced age (HR=1.40; CI, 1.13 – 1.74; p = 0.0023) and RP w/ EBRT (HR=1.49; CI, 1.14 – 1.94; p=0.0032), remained significantly associated with increased risk of acute leukemias. Radiation treatment was not significantly associated with the risk of developing chronic leukemias among pts treated with RP w/EBRT vs. RP [HR=0.91; CI, 0.72 – 1.16; p=0.45). Conclusions Among the best matched prostate cancer treatment cohorts, those who underwent EBRT following RP had a 49% increased risk of subsequent acute leukemias, although the absolute number of cases was low. Risk assessment in this cohort spans a time frame where radiation technologies have rapidly advanced and hence treatment period effects need to be considered in interpretation of results Disclosures: No relevant conflicts of interest to declare.


2004 ◽  
Vol 171 (4S) ◽  
pp. 172-172
Author(s):  
Fernand Labrie ◽  
Bernard Candas ◽  
José Luis Gomez ◽  
Leonello Cusan ◽  
Éric Chevrette ◽  
...  

2009 ◽  
Vol 13 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Annikki Jonsson ◽  
Gunnar Aus ◽  
Carina Berterö

2015 ◽  
Vol 33 (31) ◽  
pp. 3560-3567 ◽  
Author(s):  
Daniel R. Murphy ◽  
Louis Wu ◽  
Eric J. Thomas ◽  
Samuel N. Forjuoh ◽  
Ashley N.D. Meyer ◽  
...  

Purpose We tested whether prospective use of electronic health record-based trigger algorithms to identify patients at risk of diagnostic delays could prevent delays in diagnostic evaluation for cancer. Methods We performed a cluster randomized controlled trial of primary care providers (PCPs) at two sites to test whether triggers that prospectively identify patients with potential delays in diagnostic evaluation for lung, colorectal, or prostate cancer can reduce time to follow-up diagnostic evaluation. Intervention steps included queries of the electronic health record repository for patients with abnormal findings and lack of associated follow-up actions, manual review of triggered records, and communication of this information to PCPs via secure e-mail and, if needed, phone calls to ensure message receipt. We compared times to diagnostic evaluation and proportions of patients followed up between intervention and control cohorts based on final review at 7 months. Results We recruited 72 PCPs (36 in the intervention group and 36 in the control group) and applied the trigger to all patients under their care from April 20, 2011, to July 19, 2012. Of 10,673 patients with abnormal findings, the trigger flagged 1,256 patients (11.8%) as high risk for delayed diagnostic evaluation. Times to diagnostic evaluation were significantly lower in intervention patients compared with control patients flagged by the colorectal trigger (median, 104 v 200 days, respectively; n = 557; P < .001) and prostate trigger (40% received evaluation at 144 v 192 days, respectively; n = 157; P < .001) but not the lung trigger (median, 65 v 93 days, respectively; n = 19; P = .59). More intervention patients than control patients received diagnostic evaluation by final review (73.4% v 52.2%, respectively; relative risk, 1.41; 95% CI, 1.25 to 1.58). Conclusion Electronic trigger-based interventions seem to be effective in reducing time to diagnostic evaluation of colorectal and prostate cancer as well as improving the proportion of patients who receive follow-up. Similar interventions could improve timeliness of diagnosis of other serious conditions.


The Prostate ◽  
2017 ◽  
Vol 78 (3) ◽  
pp. 202-212
Author(s):  
Scott R. Bauer ◽  
Erin L. Van Blarigan ◽  
Meir J. Stampfer ◽  
June M. Chan ◽  
Stacey A. Kenfield

2018 ◽  
Vol 128 (4) ◽  
pp. 166-169
Author(s):  
Maria Pyda-Karwicka ◽  
Malwina Karwicka ◽  
Janusz Kopczyński ◽  
Magdalena Orłowska ◽  
Mariusz Krata ◽  
...  

Abstract Prostate adenocarcinoma, remaining among top most common cancers, is a heterogeneous group of tumors with a diverse morphological structure. Basing on the histological architecture of cancer tissue, individual cases can be classified into different therapeutic groups. Current diagnosis of prostate cancer brings many challenges. The major problem is the lack of effective and accessible diagnostic methods that would eliminate incidences of overdiagnosis and prevent unnecessary treatments of many patients. There are many efforts to determine favorable and unfavorable molecular prognostic factors. The basic marker currently used in this field is prostate-specific antigen (PSA). Increased level of PSA may suggest the presence of prostate cancer although its level is not specific for the disease and can be elevated also in certain benign hyperplastic or inflammatory conditions as well as after irritation or rectal examination. Clinical symptoms such as dysuria or hematuria are often uncharacteristic and benign prostatic diseases which cannot be confirmed on the basis of physical examination alone. Also, we often deal with the situation of false negative results of prostate needle biopsy, which require many tests to determine the final correct diagnosis. Moreover, prostate cancer can also be present in patients with non-elevated serum PSA level. Due to such difficulties, the search for new molecular markers that could be used for diagnostic purposes is underway. Evaluation of survivin level in prostate cancer tissue may serve as a new diagnostic indicator of prostate cancer progression. Other useful molecular biomarkers with good potential in prostate cancer diagnosis are AMACR (Alpha Methyl Acyl Coenzyme A Racemase), p-63 or Ki-67 or microRNAs present in body fluids.


Sign in / Sign up

Export Citation Format

Share Document