primary care practice autonomy influences colorectal cancer screening
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PRIMARY CARE PRACTICE AUTONOMY INFLUENCES COLORECTAL CANCER SCREENING

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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

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%)
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)
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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