Colorectal Cancer Screening in County Health Centers

Principle Investigator: 

Dorothy Lane, MD, MPH
Sponsored By:   
National Cancer Institute and the Agency for Health Care Quality and Research

STUDY 1: (Abstract from Lane DS, Messina CR, Cavanagh MF, Chen JJ. A Provider Intervention to Improve Colorectal Cancer Screening  in County Health Centers. Medical Care 2008;46:S109-116.) 
Background: Publicly-funded health centers serve disadvantaged populations who underuse colorectal cancer screening (CRC). Because physicians play a key role in patient adherence to screening, provider interventions within health center practices could improve the delivery/utilization of CRC screening.
Methods: A 2-group study design was used with 4 pairs of health centers randomized to the intervention or control condition. The provider intervention featured academic detailing of the small practice groups, followed by a strategic planning session with the entire health center staff using SWOT analysis. The outcome measure of provider endoscopy referral/fecal occult blood test dispensing and/or completion of CRC screening was determined by medical record audit (n = 2224). The intervention effect was evaluated using generalized estimating equations. Pre-post intervention patient surveys (n =281) were conducted.
Results: Chart audits of the 1 year period before and after the intervention revealed a 16% increase from baseline in CRC screening referral/dispensing/completion among intervention centers, compared with a 4% increase among controls, odds ratio (OR) = 2.25 (1.67–3.04) = 0.001. Intervention versus control health center patient self-reports of lack of physician recommendation as a reason for not having CRC screening declined from baseline to follow-up (P =0.04).
Conclusions: Provider referrals/dispensing/completion of CRC screening within health centers was significantly improved and barriers reduced through a provider intervention combining continuing medical education with a team building strategic planning exercise.

STUDY #2:  (Abstract from Messina CR, Lane DS, Colson RC. Colorectal Cancer Screening Among Users of County Health Centers and Users of Private Physician Practices. Public Health Reports 2009:568-578.)
Objective: We examined use of colorectal cancer (CRC) screening exam modalities among county health centers and private physician offices, where both were located in the same geographic area.
Methods: We surveyed 500 county health center registrants and 570 private physician patients, aged 52-75 years. We administered telephone surveys during 2004 to examine relationships among sociodemographic characteristics; perceived barriers to screening with fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy; and self-reported receipt of each exam.
Results: FOBT was more frequent among county health center registrants; sigmoidoscopy and colonoscopy were more frequent among private physician patients (p < 0.001). County health center registrants less frequently cited no physician recommendation as a barrier to FOBT, but more frequently cited no recommendation as a barrier to sigmoidoscopy and colonoscopy, compared with private physician patients (p < or = 0.02). Among county health center registrants, better health insurance coverage was associated with lower odds of FOBT and higher odds of screening endoscopy; perceived barriers were associated with lower odds of screening (p < 0.02). Among private physician patients, we noted an association between perceived barriers to screening and lower odds of any screening (p < 0.001).
Conclusions: Overall, CRC screening among county health center and private physician patient samples compared favorably with overall New York and U.S. rates. Although prior studies using national data suggested that screening rates were equivalent in county health center and private physician primary care settings, we found exam-specific differences in patient-reported screening endoscopy among our two patient samples. Understanding factors that contribute to differences in CRC screening between primary care settings is important for ensuring equal access to CRC screening options for all patients. 
Last updated by jamie.romeiser on June 16, 2011

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