Introduction: Medicaid patients with prostate cancer are four times more likely to present with metastatic disease and twice as likely to die of their cancer compared to patients with private insurance. Medicaid participation is related to other factors that limit healthcare access, including socioeconomic status (18,000/year individual income limit in Ohio) and race (48% of Medicaid enrollees are black in our county vs. 24% of population). We hypothesize that adverse prostate cancer outcomes in the Medicaid population relate to limited access to both PSA screening and evaluation of abnormal results. We reviewed our institutional triage process for patients referred for an abnormal prostate cancer screen with the goal of ensuring equitable intake processes based on payor status. Methods: This is a retrospective study of patients who presented to our institution with an elevated PSA or an abnormal prostate exam from 2012-2021. Initial data on demographics, payor status, time to first appointment, screening history, and diagnostic testing are reported. Statistical analysis was performed with SPSS (IBM Inc.). Means were compared with the student’s t-test and logistic regression was used for correlative analysis with two-tailed p values <0.05 considered significant. Results: Our initial analysis cohort included 149 patients who were predominantly Caucasian (58.0%) and had a mean age of 67.5 years (SD=9.11). Mean income based on home address zip code was $83,726 (SD=$30,488) and patients had a mean of 2.91 (SD=1.2) prior PSAs. We had a much lower proportion of patients with Medicaid status (6.7%) than expected based on our overall departmental payor mix and the size of the Medicaid population in our catchment area. Patients with Medicaid were almost 10 times more likely to not show up to their first appointment than those with other insurance types (p=0.014). Medicaid patients were also less likely to receive a biopsy (p=0.07) and had a lower number of PSA tests prior to referral (p=0.08). A zip code with lower mean income negatively predicted receipt of MRI prior to a biopsy (p=0.02). Times between referral, scheduling, and appointment were not impacted by payor status or zip code. Conclusions: Our data confirm disparities in several factors in our prostate cancer screening referrals known to relate to prostate cancer outcomes. To address this, we are implementing a Medicaid-focused program at our institution to improve on “No-show” rates and optimize guideline concordant care. Outreach to primary care providers with a large Medicaid patient population is also critical in promoting equity in PSA screening. SOURCE OF Funding: Ohio State University Patient Care Innovation Award
