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Primary Care Practice Organization Influences Colorectal Cancer Screening Performance

Authors

  • Elizabeth M. Yano,

    1. VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda VA Ambulatory Care Center (152), 16111 Plummer Street, Sepulveda, CA 91343,
    2. Department of Health Services, UCLA School of Public Health, Los Angeles, CA,
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    • Address correspondence to Elizabeth M. Yano, Ph.D., M.S.P.H., VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda VA Ambulatory Care Center (152), 16111 Plummer Street, Sepulveda, CA 91343. Dr. Yano is also with the Department of Health Services, UCLA School of Public Health, Los Angeles, CA. Lynn M. Soban, Ph.D., R.N., and Patricia H. Parkerton, Ph.D., M.P.H., are with the VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA. Patricia H. Parkerton, Ph.D., M.P.H., is also with the Department of Health Services, UCLA School of Public Health, Los Angeles, CA. David A. Etzioni, M.D., M.P.H., is with the Department of Colorectal Cancer Surgery, University of Minnesota, Minneapolis, MN.

  • Lynn M. Soban,

    1. VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA,
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  • Patricia H. Parkerton,

    1. VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA,
    2. Department of Health Services, UCLA School of Public Health, Los Angeles, CA,
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  • David A. Etzioni

    1. Department of Colorectal Cancer Surgery, University of Minnesota, Minneapolis, MN.
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Abstract

Objective. To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors.

Data Sources/Study Setting. Primary care director survey (1999–2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001).

Study Design. Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors.

Data Collection/Extraction Methods. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease.

Principal Findings. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001).

Conclusions. Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

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