Inappropriate Breast, Prostate Imaging Regionally Clustered

Danil Makarov, MD Lead Investigator Assistant Professor, Departments of Urology, Population Health and Health Policy Member, Laura and Isaac Perlmutter Cancer Center NYU Langone Medical Center, New York, NYMedicalResearch.com Interview with:
Danil Makarov, MD Lead Investigator
Assistant Professor, Departments of Urology, Population Health and Health Policy
Member, Laura and Isaac Perlmutter Cancer Center
NYU Langone Medical Center, New York, NY

Medical Research: What is the background for this study?

Dr. Makarov: The background for this study is that regional variation in patterns of care and healthcare spending is widely known.  The drivers of this regional variation, though, are poorly understood.  Certain policy groups like the IOM have suggested that policy efforts be focused on individual providers and patients. Programs such as Choosing Wisely, which encourage a dialogue between physicians and patients, are a great example of such efforts.  However, some of our prior research suggests that regional variation is not random and that there might be are regional-level factors which drive variation.

To test out our hypothesis, we wanted to see whether inappropriate imaging for two unrelated cancers was associated at a regional level (it should not be).

Medical Research: What are the main findings?

Dr. Makarov: We found that, at a regional level, inappropriate breast cancer imaging was associated with inappropriate prostate cancer imaging.

Medical Research: What should clinicians and patients take away from your report?

Dr. Makarov: This finding suggests that regional factors (such as practice norms and medical culture) might be driving regional variation.  If proven correct, this might suggest that policy interventions should be regionally targeted based on the presence of these local factors.  Choosing wisely is a great first step at encouraging patient and physician participation in healthcare decisions but may not be able to entirely resolve the problems of inappropriate use and regional variation.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Makarov: Future research needs to explore further the associations between appropriateness of care across disease states and needs to determine evidence of these practice norms and medical culture using qualitative methods.
Citation:

Regional-Level Correlations in Inappropriate Imaging Rates for Prostate and Breast CancersPotential Implications for the Choosing Wisely Campaign. JAMA Oncology, March 2015 DOI: 10.1001/jamaoncol.2015.37

MedicalResearch.com Interview with: Danil Makarov, MD Lead Investigator (2015). Inappropriate Breast, Prostate Imaging Regionally Clustered