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Imaging (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> MRI<\/jats:styled-content>, bone scan, <jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>) use was assessed among patients with low\u2010risk disease, for whom guidelines recommend against advanced imaging, and among high\u2010risk patients for whom guidelines recommend it.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>We found high rates of inappropriate imaging among men with low\u2010risk prostate cancer (41 percent) and suboptimal rates of appropriate imaging among men with high\u2010risk disease (70 percent). Veterans utilizing Medicare\u2010reimbursed care had higher rates of inappropriate imaging [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 1.09 (1.03\u20131.16)] but not higher rates of appropriate imaging. Veterans treated in middle [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 0.51 (0.47\u20130.56)] and higher [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 0.50 (0.46\u20130.55)] volume medical centers were less likely to undergo inappropriate imaging without compromising appropriate imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results highlight the overutilization of imaging, even in an integrated health care system without financial incentives encouraging provision of health care services. Paradoxically, imaging remains underutilized among high\u2010risk patients who could potentially benefit from it most.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.12395","type":"journal-article","created":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T03:29:34Z","timestamp":1443670174000},"page":"1021-1051","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Appropriateness of Prostate Cancer Imaging among Veterans in a Delivery System without Incentives for Overutilization"],"prefix":"10.1111","volume":"51","author":[{"given":"Danil V.","family":"Makarov","sequence":"first","affiliation":[{"name":"VA New York Harbor Healthcare System New York University New York NY"},{"name":"Department of Urology New York University New York NY"},{"name":"Department of Population Health New York University New York NY"},{"name":"Cancer Institute New York University New York NY"},{"name":"Robert F. 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Scott","family":"Braithwaite","sequence":"additional","affiliation":[{"name":"Department of Population Health New York University New York NY"},{"name":"Cancer Institute New York University New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Sherman","sequence":"additional","affiliation":[{"name":"VA New York Harbor Healthcare System New York University New York NY"},{"name":"Department of Population Health New York University New York NY"},{"name":"Cancer Institute New York University New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather T.","family":"Gold","sequence":"additional","affiliation":[{"name":"Department of Population Health New York University New York NY"},{"name":"Cancer Institute New York University New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Hua Andrew","family":"Zhou","sequence":"additional","affiliation":[{"name":"VA Puget Sound Healthcare System and University of Washington Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary P.","family":"Gross","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Clinical Scholars Program and Department of Internal Medicine Yale University School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven B.","family":"Zeliadt","sequence":"additional","affiliation":[{"name":"VA Puget Sound Healthcare System and University of Washington Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,9,30]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"American Board of Internal Medicine.2012. \u201cAmerican Board of Internal Medicine Foundation: The Choosing Wisely Campaign: Five Things Physicians and Patients Should Question\u201d [accessed on May 5 2012]. 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