Primary care practice autonomy influences colorectal cancer screening
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PRIMARY CARE PRACTICE AUTONOMY INFLUENCES COLORECTAL CANCER SCREENING PowerPoint PPT Presentation


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PRIMARY CARE PRACTICE AUTONOMY INFLUENCES COLORECTAL CANCER SCREENING. Patricia H. Parkerton, PhD MPH Elizabeth M. Yano, PhD MSPH Lynn M. Soban, MPH BSN David A. Etzioni, MD MSHS. Supported by. Department of Veterans’ Affairs (VA) HSR&D : Health Services Research and

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PRIMARY CARE PRACTICE AUTONOMY INFLUENCES COLORECTAL CANCER SCREENING

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Primary care practice autonomy influences colorectal cancer screening

PRIMARY CARE PRACTICEAUTONOMY INFLUENCESCOLORECTAL CANCER SCREENING

Patricia H. Parkerton, PhD MPH

Elizabeth M. Yano, PhD MSPH

Lynn M. Soban, MPH BSN

David A. Etzioni, MD MSHS


Supported by

Supported by

  • Department of Veterans’ Affairs (VA)

    • HSR&D:

      Health Services Research and

      Development

    • QUERI:

      Quality Enhancement Research

      Initiative, Colorectal Cancer


Objectives

Objectives

  • Determine sources of CRC

    screening variation

  • Determine role of practice and

    clinical leader autonomy


Colorectal cancer crc screening modalities

Colorectal Cancer (CRC) Screening Modalities

Chart documentation of:

  • FOBT in last year,

  • Flexible sigmoidoscopy in last 5 years

    or

  • Colonoscopy in last 10 years


Crc screening rates cdc 2001

CRC Screening Rates: CDC 2001

  • #2 cause of cancer deaths (57,000)

  • Early detection reduces mortality

  • National average: 53%

  • Variation by State: 42--65%


Crc screening at the va department of veterans affairs

CRC Screening at the VA Department of Veterans’ Affairs

  • Mean 60%

  • Varies by

    • Region: 55% to 62%

    • Facility: 25% to 88%

  • Lowest preventive measure at VA medical centers


  • Facility population

    Facility Population

    • All VA primary-care sites

    • Serving >4,000 primary care patients

    • Delivering >20,000 primary care visits

    • N=235

    • Response 219 sites (93%)


    Leader autonomy on colorectal cancer screening

    Leader Autonomy onColorectal Cancer Screening


    Primary care practice autonomy influences colorectal cancer screening

    Control Variables


    Study variables

    Study Variables


    Data sources

    Data Sources

    • CRC screening rates from the

      • External Peer Review Program of

      • 71,000 charts (2001)

    • Organizational structures and processes from the

    • Primary Care Practices Survey (2000)


    Primary care leader autonomy scale

    Primary Care Leader Autonomy Scale *


    Crc screening and autonomy correlations

    CRC Screening and Autonomy Correlations


    Regression results autonomy on crc screening

    Regression Results: Autonomy on CRC Screening


    Regression results full model

    Regression Results: Full Model


    Conclusions

    Conclusions

    • Primary care practice leader

      autonomy was associated with

      higher CRC screening

    • No other measure altered this

      relationship: academic affiliation,

      quality improvement, or size


    Limitations

    Limitations

    • Facilities within one health system

    • 1999-2000 data in changing times

    • Captures perceptions not actual activity

    • Leader characteristics are unmeasured


    Implications potential impact

    Implications/Potential Impact:

    • Increasing Clinical Leader Autonomy

      over practice arrangements may

      • enhance receipt of preventive

        services

      • result in earlier detection of cancer

      • lower mortality

    • Value of Autonomy relative to needs for consistency needs further exploration


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