Urology practice · 2026
Variability and Hospital-Level Predictors of Magnetic Resonance Imaging for Elevated Prostate Specific Antigen: Results of a Medicare and American Hospital Association Linkage.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Piccolini Andrea, Korn Stephan, Qian Zhiyu, Zurl Hanna, Pohl Klara K, Brin Pietro, Xiao Boyuan, Zhang Jianyi, Lipsitz Stuart, Rebbeck Timothy R, Kilbridge Kerry L, Kibel Adam S, Lughezzani Giovanni, Buffi Nicolò M, Trinh Quoc-Dien, Cole Alexander P
Аннотация
INTRODUCTION: Despite level 1 evidence supporting prostate MRI for suspected prostate cancer, its use remains limited in the United States. The impact of patient-level and hospital-level factors on MRI use after a new elevated PSA among Medicare beneficiaries is unclear. We evaluated these factors to explain variation in MRI utilization.
METHODS: We conducted a retrospective study of Medicare beneficiaries with newly elevated PSA (2019-2023), linked to hospital-level data from the American Hospital Association Annual Survey. The primary outcome was receipt of MRI for elevated PSA, modeled using a generalized linear mixed model with a binomial distribution and logit link function. Patient-level and hospital-level covariates were included, and their relative contributions assessed using Cox and Snell pseudo-R2 statistics.
RESULTS: Of 304,161 patients across 2657 hospitals, the top quartile of hospitals achieved a mean prebiopsy MRI utilization rate of 8.5% (SD: 2.9) and the bottom quartile reported rates below 1.75%. Black patients were more likely to undergo MRI than White patients (OR: 1.15, 95% CI: 1.06-1.26; P < .001), as were those residing in metropolitan areas. Major teaching hospitals were associated with increased MRI use (OR: 1.19; 95% CI: 1.07-1.32; P = .001). Patient-level variables explained 37.2% of the variance in MRI utilization, while hospital-level factors accounted for less than 1%.
CONCLUSIONS: Patient-level factors represent the primary drivers of variation in prebiopsy MRI use, with minimal contribution from hospital characteristics. Efforts to improve equity in prostate cancer care should prioritize reducing patient-level barriers and standardizing referral practices across institutions.
METHODS: We conducted a retrospective study of Medicare beneficiaries with newly elevated PSA (2019-2023), linked to hospital-level data from the American Hospital Association Annual Survey. The primary outcome was receipt of MRI for elevated PSA, modeled using a generalized linear mixed model with a binomial distribution and logit link function. Patient-level and hospital-level covariates were included, and their relative contributions assessed using Cox and Snell pseudo-R2 statistics.
RESULTS: Of 304,161 patients across 2657 hospitals, the top quartile of hospitals achieved a mean prebiopsy MRI utilization rate of 8.5% (SD: 2.9) and the bottom quartile reported rates below 1.75%. Black patients were more likely to undergo MRI than White patients (OR: 1.15, 95% CI: 1.06-1.26; P < .001), as were those residing in metropolitan areas. Major teaching hospitals were associated with increased MRI use (OR: 1.19; 95% CI: 1.07-1.32; P = .001). Patient-level variables explained 37.2% of the variance in MRI utilization, while hospital-level factors accounted for less than 1%.
CONCLUSIONS: Patient-level factors represent the primary drivers of variation in prebiopsy MRI use, with minimal contribution from hospital characteristics. Efforts to improve equity in prostate cancer care should prioritize reducing patient-level barriers and standardizing referral practices across institutions.