5 Citations (Scopus)

Abstract

Objective: To identify patient, provider, and delivery system-level factors associated with colorectal cancer (CRC) screening and validate findings across multiple data sets. Design: A concurrent mixed-methods design using electronic health records, provider survey, and provider interview. Setting: Eight primary care accountable care organization clinics in Nebraska. Measures: Patients' demographic/social characteristics, health utilization behaviors, and perceptions toward CRC screening; provider demographics and practice patterns; and clinics' delivery systems (eg, reminder system). Analysis: Quantitative (frequencies, logistic regression, and t tests) and qualitative analyses (thematic coding). Results: At the patient level, being 65 years of age and older (odds ratio [OR] = 1.34, P <.001), being non-Hispanic white (OR = 1.93, P <.001), having insurance (OR = 1.90, P =.01), having an annual physical examination (OR = 2.36, P <.001), and having chronic conditions (OR = 1.65 for 1-2 conditions, P <.001) were associated positively with screening, compared with their counterparts. The top 5 patient-level barriers included discomfort/pain of the procedure (60.3%), finance/cost (57.4%), other priority health issues (39.7%), lack of awareness (36.8%), and health literacy (26.5%). At the provider level, being female (OR = 1.88, P <.001), having medical doctor credentials (OR = 3.05, P <.001), and having a daily patient load less than 15 (OR = 1.50, P =.01) were positively related to CRC screening. None of the delivery system factors were significant except the reminder system. Interview data provided in-depth information on how these factors help or hinder CRC screening. Discrepancies in findings were observed in chronic condition, colonoscopy performed by primary doctors, and the clinic-level system factors. Conclusions: This study informs practitioners and policy makers on the effective multilevel strategies to promote CRC screening in primary care accountable care organization or equivalent settings. Some inconsistent findings between data sources require additional prospective cohort studies to validate those identified factors in question. The strategies may include (1) developing programs targeting relatively younger age groups or racial/ethnic minorities, (2) adapting multilevel/multicomponent interventions to address low demands and access of local population, (3) promoting annual physical examination as a cost-effective strategy, and (4) supporting organizational capacity and infrastructure (eg, IT system) to facilitate implementation of evidence-based interventions.

Original languageEnglish (US)
Pages (from-to)562-570
Number of pages9
JournalJournal of Public Health Management and Practice
Volume25
Issue number6
DOIs
StatePublished - Nov 1 2019

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Accountable Care Organizations
Early Detection of Cancer
Colorectal Neoplasms
Primary Health Care
Odds Ratio
Reminder Systems
Physical Examination
Demography
Interviews
Health Literacy
Costs and Cost Analysis
Health Priorities
Electronic Health Records
Information Storage and Retrieval
Colonoscopy
Insurance
Administrative Personnel
Cohort Studies
Age Groups
Logistic Models

Keywords

  • accountable care organizations
  • colorectal cancer screening
  • mixed-methods
  • primary care
  • triangulation

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

@article{e2ff4731f54a454e997a7ed3befc0f60,
title = "An Examination of Multilevel Factors Influencing Colorectal Cancer Screening in Primary Care Accountable Care Organization Settings: A Mixed-Methods Study",
abstract = "Objective: To identify patient, provider, and delivery system-level factors associated with colorectal cancer (CRC) screening and validate findings across multiple data sets. Design: A concurrent mixed-methods design using electronic health records, provider survey, and provider interview. Setting: Eight primary care accountable care organization clinics in Nebraska. Measures: Patients' demographic/social characteristics, health utilization behaviors, and perceptions toward CRC screening; provider demographics and practice patterns; and clinics' delivery systems (eg, reminder system). Analysis: Quantitative (frequencies, logistic regression, and t tests) and qualitative analyses (thematic coding). Results: At the patient level, being 65 years of age and older (odds ratio [OR] = 1.34, P <.001), being non-Hispanic white (OR = 1.93, P <.001), having insurance (OR = 1.90, P =.01), having an annual physical examination (OR = 2.36, P <.001), and having chronic conditions (OR = 1.65 for 1-2 conditions, P <.001) were associated positively with screening, compared with their counterparts. The top 5 patient-level barriers included discomfort/pain of the procedure (60.3{\%}), finance/cost (57.4{\%}), other priority health issues (39.7{\%}), lack of awareness (36.8{\%}), and health literacy (26.5{\%}). At the provider level, being female (OR = 1.88, P <.001), having medical doctor credentials (OR = 3.05, P <.001), and having a daily patient load less than 15 (OR = 1.50, P =.01) were positively related to CRC screening. None of the delivery system factors were significant except the reminder system. Interview data provided in-depth information on how these factors help or hinder CRC screening. Discrepancies in findings were observed in chronic condition, colonoscopy performed by primary doctors, and the clinic-level system factors. Conclusions: This study informs practitioners and policy makers on the effective multilevel strategies to promote CRC screening in primary care accountable care organization or equivalent settings. Some inconsistent findings between data sources require additional prospective cohort studies to validate those identified factors in question. The strategies may include (1) developing programs targeting relatively younger age groups or racial/ethnic minorities, (2) adapting multilevel/multicomponent interventions to address low demands and access of local population, (3) promoting annual physical examination as a cost-effective strategy, and (4) supporting organizational capacity and infrastructure (eg, IT system) to facilitate implementation of evidence-based interventions.",
keywords = "accountable care organizations, colorectal cancer screening, mixed-methods, primary care, triangulation",
author = "Jungyoon Kim and Hongmei Wang and Lufei Young and Michaud, {Tzeyu L.} and Mohammad Siahpush and Farazi, {Paraskevi A.} and Chen, {Li Wu}",
year = "2019",
month = "11",
day = "1",
doi = "10.1097/PHH.0000000000000837",
language = "English (US)",
volume = "25",
pages = "562--570",
journal = "Journal of Public Health Management and Practice",
issn = "1078-4659",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - An Examination of Multilevel Factors Influencing Colorectal Cancer Screening in Primary Care Accountable Care Organization Settings

T2 - A Mixed-Methods Study

AU - Kim, Jungyoon

AU - Wang, Hongmei

AU - Young, Lufei

AU - Michaud, Tzeyu L.

AU - Siahpush, Mohammad

AU - Farazi, Paraskevi A.

AU - Chen, Li Wu

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objective: To identify patient, provider, and delivery system-level factors associated with colorectal cancer (CRC) screening and validate findings across multiple data sets. Design: A concurrent mixed-methods design using electronic health records, provider survey, and provider interview. Setting: Eight primary care accountable care organization clinics in Nebraska. Measures: Patients' demographic/social characteristics, health utilization behaviors, and perceptions toward CRC screening; provider demographics and practice patterns; and clinics' delivery systems (eg, reminder system). Analysis: Quantitative (frequencies, logistic regression, and t tests) and qualitative analyses (thematic coding). Results: At the patient level, being 65 years of age and older (odds ratio [OR] = 1.34, P <.001), being non-Hispanic white (OR = 1.93, P <.001), having insurance (OR = 1.90, P =.01), having an annual physical examination (OR = 2.36, P <.001), and having chronic conditions (OR = 1.65 for 1-2 conditions, P <.001) were associated positively with screening, compared with their counterparts. The top 5 patient-level barriers included discomfort/pain of the procedure (60.3%), finance/cost (57.4%), other priority health issues (39.7%), lack of awareness (36.8%), and health literacy (26.5%). At the provider level, being female (OR = 1.88, P <.001), having medical doctor credentials (OR = 3.05, P <.001), and having a daily patient load less than 15 (OR = 1.50, P =.01) were positively related to CRC screening. None of the delivery system factors were significant except the reminder system. Interview data provided in-depth information on how these factors help or hinder CRC screening. Discrepancies in findings were observed in chronic condition, colonoscopy performed by primary doctors, and the clinic-level system factors. Conclusions: This study informs practitioners and policy makers on the effective multilevel strategies to promote CRC screening in primary care accountable care organization or equivalent settings. Some inconsistent findings between data sources require additional prospective cohort studies to validate those identified factors in question. The strategies may include (1) developing programs targeting relatively younger age groups or racial/ethnic minorities, (2) adapting multilevel/multicomponent interventions to address low demands and access of local population, (3) promoting annual physical examination as a cost-effective strategy, and (4) supporting organizational capacity and infrastructure (eg, IT system) to facilitate implementation of evidence-based interventions.

AB - Objective: To identify patient, provider, and delivery system-level factors associated with colorectal cancer (CRC) screening and validate findings across multiple data sets. Design: A concurrent mixed-methods design using electronic health records, provider survey, and provider interview. Setting: Eight primary care accountable care organization clinics in Nebraska. Measures: Patients' demographic/social characteristics, health utilization behaviors, and perceptions toward CRC screening; provider demographics and practice patterns; and clinics' delivery systems (eg, reminder system). Analysis: Quantitative (frequencies, logistic regression, and t tests) and qualitative analyses (thematic coding). Results: At the patient level, being 65 years of age and older (odds ratio [OR] = 1.34, P <.001), being non-Hispanic white (OR = 1.93, P <.001), having insurance (OR = 1.90, P =.01), having an annual physical examination (OR = 2.36, P <.001), and having chronic conditions (OR = 1.65 for 1-2 conditions, P <.001) were associated positively with screening, compared with their counterparts. The top 5 patient-level barriers included discomfort/pain of the procedure (60.3%), finance/cost (57.4%), other priority health issues (39.7%), lack of awareness (36.8%), and health literacy (26.5%). At the provider level, being female (OR = 1.88, P <.001), having medical doctor credentials (OR = 3.05, P <.001), and having a daily patient load less than 15 (OR = 1.50, P =.01) were positively related to CRC screening. None of the delivery system factors were significant except the reminder system. Interview data provided in-depth information on how these factors help or hinder CRC screening. Discrepancies in findings were observed in chronic condition, colonoscopy performed by primary doctors, and the clinic-level system factors. Conclusions: This study informs practitioners and policy makers on the effective multilevel strategies to promote CRC screening in primary care accountable care organization or equivalent settings. Some inconsistent findings between data sources require additional prospective cohort studies to validate those identified factors in question. The strategies may include (1) developing programs targeting relatively younger age groups or racial/ethnic minorities, (2) adapting multilevel/multicomponent interventions to address low demands and access of local population, (3) promoting annual physical examination as a cost-effective strategy, and (4) supporting organizational capacity and infrastructure (eg, IT system) to facilitate implementation of evidence-based interventions.

KW - accountable care organizations

KW - colorectal cancer screening

KW - mixed-methods

KW - primary care

KW - triangulation

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