Reducing inappropriate PSA-based prostate cancer screening in men age 75 or older with a highly specific computerized clinical decision support tool.

233 Background: The value of PSA-based screening for prostate cancer is a topic of intense debate, however the Veterans Health Administration's (VHA) national clinical policy is to use age as a proxy for life expectancy and avoid screening in men ≥ age 75. To facilitate this we developed and implemented a highly specific computerized clinical decision support (CCDS) reminder to remind providers of current guidelines, at the moment of entering an inappropriate PSA order. Methods: We defined screening PSA as: any PSA ordered on men excluding those a) with a diagnosis of existing malignant prostate disease or “elevated prostate specific antigen”, b) who are using either enhancers or suppressors of testosterone, or d) who had a PSA of 2.5ng/ml or greater on either of the two most recent PSA tests. We measured PSA-based prostate cancer screening rates using this definition and on a monthly basis from 07/2011 to 07/2013. Using an interrupted time-series design, we turned the reminder on from 6/2012-8/2012 and t...