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Age-Based Quality Measure Is Associated with Overuse of Colorectal Cancer Screening in Unhealthy Elders

Summary and Comment |
March 20, 2014

Age-Based Quality Measure Is Associated with Overuse of Colorectal Cancer Screening in Unhealthy Elders

  1. Paul S. Mueller, MD, MPH, FACP

A 75-year-old with limited life expectancy was more likely to be screened than a healthy 76-year-old with 10-year life expectancy.

  1. Paul S. Mueller, MD, MPH, FACP

The U.S. Veterans Affairs (VA) Health System has an age-based quality measure for colorectal cancer screening: 75 is the upper age cutoff. In this retrospective study, investigators determined whether this age-based quality measure for colorectal cancer screening is associated with overuse of screening in 70- to 75-year-old veterans with poor health and short life expectancy and underuse of screening in older veterans (age, ≥76) with good health and long life expectancy.

The study included 400,000 veterans (mean age, 67) who were seen in VA primary care clinics in 2010 and were due for routine colorectal cancer screening. Screening rates were about 45% throughout the age range of 50 to 75. However, among older veterans, screening rates were much lower (about 16%), independent of comorbidity status and patient characteristics (relative risk, 0.4). In fact, an unhealthy 75-year-old with limited life expectancy was significantly more likely to undergo screening than a healthy 76-year-old with long life expectancy (unadjusted RR, 1.6).

Comment

In this study, a VA age-based quality measure promoted overuse of colorectal cancer screening in unhealthy elders and underuse in healthy elders. Notably, U.S. Preventive Services Task Force guidelines recommend screening average-risk adults between ages 50 and 75, but allow for tailoring of cancer screening in older patients (age range, 76–85) based on health status and other factors (NEJM JW Gen Med Oct 28 2008).Unlike guidelines, quality measures tend to be rigid, simplistic, and mandatory (JAMA 2004; 291:2466) and — as this study suggests — might unintentionally result in poorer quality of care.

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Secretary)

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Reader Comments (1)

Alice

With screening rates being at 45% for age 50-75 population it represents a large component that was not examined. Whether that is because the other 55% did not need this screening is not discussed.

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