Regional Variation Of The National Abdominal Aortic Aneurysm Screening Program In The U.s. Veteran Population
Manuel Garcia-Toca, MD,MS1, Elizabeth L. George, MD, MS1, Nathan Itoga, MD, MS1, Jordan R. Stern, MD1, Michael D. Sgroi, MD1, Oliver Aalami, MD2.
1Stanford University, Stanford, CA, USA, 2Stanford University, STANFORD, CA, USA.
OBJECTIVES: In January 2007, the Department of Veterans Affairs (VA) launched a national Abdominal Aortic Aneurysm (AAA) screening program. Our objective was to describe and compare temporal and geographic utilization trends for AAA screening in the Veteran’s Health Administration (VHA).
METHODS:A national cohort of AAA screened veterans was evaluated retrospectively to calculate annual overall and regional rates of AAA screening utilization. Veterans with an AAA screening study between 2007 and 2018 were identified using the two existing Current Procedural Terminology (CPT) codes (G0389 and 76706). Survival estimates were calculated after AAA screening with or without an AAA diagnosis, and a multivariate Cox regression model was used in patients with a positive AAA diagnosis to adjust for patient characteristics and comorbidities. Screening rates (unique Veterans screened per AAA screening eligible population) were compared across Veterans Integrated Service Networks (VISNs).
RESULTS:Overall, 322,042 veterans had an AAA ultrasound screening performed; 2852 patients were excluded from the analysis because a AAA diagnosis was recorded in the Health Electronic Record before the screening study was performed. A total of 15,449 patients (4.84%) had a AAA diagnosis. AAA screening increased over time within all geographic regions; screening rates among eligible Veterans in the population varied significantly across VISN. (Figure 1). The highest proportion of studies performed was in the North Atlantic District (30.4%), and the lowest in the Continental region (11.6%) p<.0001. Of the total AAA screening studies (n=322,042), 20.8% were performed in five VA medical centers (Upstate New York, Northern California, Atlanta GA, Fayetteville AR, and Orlando Fl.) Multivariate Cox regression analysis in patients with AAA diagnosis demonstrated a significantly lower 5-year mortality for patients from the Midwest and North Atlantic regions [HR 0.80 (95% CI 0.66-0.98) and 0.81 (95% CI 0.67-0.97)] p<0.021.
CONCLUSIONS:In a nationwide analysis of VA patients, the AAA screening program had substantial regional utilization variation, with increased adoption over time. The reasons for the regional variation and the degree of utilization of AAA screening in the VA, as in other healthcare systems, are likely multifactorial and exist at the patient, provider, and healthcare system levels. 
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