Mp70-12 Active Surveillance and Confirmatory Testing Among Medicaid Patients: Results From the Michigan Urological Surgery Improvement Collaborative

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes III (MP70)1 May 2024MP70-12 ACTIVE SURVEILLANCE AND CONFIRMATORY TESTING AMONG MEDICAID PATIENTS: RESULTS FROM THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE Arnav Srivastava, Stephanie Daignault-Newton, Sabir Meah, Kassem Faraj, Kevin Ginsburg, Firas Abdollah, Corinne Labardee, Anna Johnson, Alice Semerjian, Keow Goh, Brent Hollenbeck, Vahakn Shahinian, Lindsey Herrel, Tudor Borza, and for the Michigan Urological Surgery Improvement Collaborative Arnav SrivastavaArnav Srivastava , Stephanie Daignault-NewtonStephanie Daignault-Newton , Sabir MeahSabir Meah , Kassem FarajKassem Faraj , Kevin GinsburgKevin Ginsburg , Firas AbdollahFiras Abdollah , Corinne LabardeeCorinne Labardee , Anna JohnsonAnna Johnson , Alice SemerjianAlice Semerjian , Keow GohKeow Goh , Brent HollenbeckBrent Hollenbeck , Vahakn ShahinianVahakn Shahinian , Lindsey HerrelLindsey Herrel , Tudor BorzaTudor Borza , and for the Michigan Urological Surgery Improvement Collaborative View All Author Informationhttps://doi.org/10.1097/01.JU.0001008796.84999.75.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Confirmatory testing in active surveillance (AS) protocols verifies the extent of prostate cancer in patients electing surveillance. Despite its importance, confirmatory testing is inconsistently utilized leading to potential disparities in care. We assessed the use of confirmatory testing among Medicaid patients, who may face barriers to follow up and protocol adherence compared to their privately insured counterparts. METHODS: We identified men with prostate cancer eligible for AS (i.e., low or favorable intermediate risk disease), from the Michigan Urological Surgery Improvement Collaborative from 2016-2021. A logistic regression model assessed the association of treatment choice and payer status by cancer risk group using an interaction effect adjusting for age, race, comorbidity index, and BMI. We compared confirmatory testing – defined as repeat prostate biopsy, MRI, or genomic test within 6 months of initial diagnosis – by payer using Kaplan-Meier methods. When assessing confirmatory testing over time, men undergoing MRI prior to biopsy were counted as receiving confirmatory testing. Men undergoing primary treatment without confirmatory testing were censored at the time of treatment. RESULTS: We identified 17,138 AS eligible patients with most covered by private insurance (N=9756, 57%), followed by Medicare (N=6933, 40%) and Medicaid (N=449, 3%). Patients with private insurance and Medicaid had similar proportions of AS in low (65% vs. 67%) and favorable intermediate risk (20% vs. 19%) disease. In an adjusted analysis, patients with private insurance and Medicaid did not demonstrate different odds of choosing AS (low risk OR 0.99, 95% CI 0.71-1.4, intermediate risk OR 0.98, 95% CI 0.72-1.34). At 6 months privately insured patients had a 60% rate of confirmatory testing compared with 50% for Medicaid patients (log rank: p=0.001) (Figure 1). CONCLUSIONS: A significant proportion of men on AS, roughly 40%, did not undergo confirmatory testing within 6 months of diagnosis. While both men with private insurance and Medicaid have suboptimal testing rates, Medicaid patients appear more likely to miss confirmatory testing. Confirmatory testing represents a key quality improvement target to ensure appropriate patients are offered AS. Download PPT Source of Funding: Funding: From Blue Cross Blue Shield of MichiganArnav Srivastava is supported by a training grant from the National Cancer Institute: T32CA180984 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1133 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Arnav Srivastava More articles by this author Stephanie Daignault-Newton More articles by this author Sabir Meah More articles by this author Kassem Faraj More articles by this author Kevin Ginsburg More articles by this author Firas Abdollah More articles by this author Corinne Labardee More articles by this author Anna Johnson More articles by this author Alice Semerjian More articles by this author Keow Goh More articles by this author Brent Hollenbeck More articles by this author Vahakn Shahinian More articles by this author Lindsey Herrel More articles by this author Tudor Borza More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...