Diabetes and Cancer Screening Rates among Appalachian and Non-Appalachian Residents of Kentucky

Fleming, Steven T.; Love, Margaret M.; Bennett, Keisa

doi:10.3122/jabfm.2011.06.110094

Cited by 26 publications

(30 citation statements)

References 27 publications

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“…Screening in accordance with guidelines has been estimated at 49% in Appalachian Ohio (37), which has among the lowest rates of uninsured in Appalachia (22). Fleming and colleagues found that among Kentucky residents, those living in Appalachia were half as likely as non-Appalachians to report endoscopy screening for colorectal cancer in the past 10 years (38). While colorectal cancer screening rates for the Mississippi Delta are not available, breast cancer screening has been shown to be lower there than in the rest of the United States (39).…”

Section: Discussionmentioning

confidence: 99%

Where Can Colorectal Cancer Screening Interventions Have the Most Impact?

Siegel

Sahar

Robbins

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

103

112

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Background: Although colorectal cancer death rates in the United States have declined by half since 1970, large geographic disparities persist. Spatial identification of high-risk areas can facilitate targeted screening interventions to close this gap.Methods: We used the Getis-Ord Gi Ã statistic within ArcGIS to identify contemporary colorectal cancer "hotspots" (spatial clusters of counties with high rates) based on county-level mortality data from the national vital statistics system. Hotspots were compared with the remaining aggregated counties (non-hotspot United States) by plotting trends from 1970 to 2011 and calculating rate ratios (RR). Trends were quantified using joinpoint regression.Results: Spatial mapping identified three distinct hotspots in the contemporary United States where colorectal cancer death rates were elevated. The highest rates were in the largest hotspot, which encompassed 94 counties in the Lower Mississippi Delta

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Section: Discussionmentioning

confidence: 99%

Where Can Colorectal Cancer Screening Interventions Have the Most Impact?

Siegel

Sahar

Robbins

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

103

112

View full text Add to dashboard Cite

show abstract

“…Previous investigations have assessed CRC screening patterns among Appalachian populations and many of these studies have documented lower CRC screening rates, with reported rates as low as 32% [24, 25, 27–29, 32]. Since CRC screening rates are low and there is an increase in CRC mortality rates among residents of Appalachia Ohio, innovative strategies are needed to increase CRC screening rates.…”

Section: Introductionmentioning

confidence: 99%

Correlates of Colorectal Cancer Screening Among Residents of Ohio Appalachia

et al. 2013

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There is an excess burden of colorectal cancer (CRC) in the Appalachian region of the U.S., which could be reduced by increased uptake of CRC screening tests. Thus, we examined correlates of screening among Appalachian residents at average-risk for CRC. Using a population-based sample, we conducted interviews with and obtained medical records of Appalachian Ohio residents 50–75 years between September 2009 and April 2010. Using multivariable logistic regression, we identified correlates of being within CRC screening guidelines by medical records. About half of participants were within CRC screening guidelines. Participants who were older (OR=1.04, 95% CI: 1.01, 1.07), had higher income ($30,000–$60,000, OR=1.92, 95% CI: 1.29, 2.86; ≥$60,000, OR=1.80, 95% CI: 1.19, 2.72), a primary care provider (OR=4.22, 95% CI: 1.33, 13.39), a recent check-up (OR=2.37, 95% CI: 1.12, 4.99), had been encouraged to be screened (OR=1.57, 95% CI: 1.11, 2.22), had been recommended by their doctor to be screened (OR=6.68, 95% CI: 3.87, 11.52), or asked their doctor to order a screening test (OR=2.24, 95% CI: 1.36, 3.69) had higher odds of being screened within guidelines in multivariable analysis. Findings suggest that access to and utilization of healthcare services, social influence, and patient-provider communication were the major factors associated with CRC screening. Researchers and healthcare providers should develop and implement strategies targeting these barriers/facilitators to improve CRC screening rates and reduce the CRC burden among residents of Appalachia.

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“…11 Women with diabetes had lower rates of mammography screening, though not of clinical breast examination. The differences in screening rates were approximately 10% to 15%.…”

Section: Cancer Screening and Follow-upmentioning

confidence: 99%

Change, Lack of Change, and Creating Optimal Change Out of Chaos

Bowman¹,

Neale²

2011

The Journal of the American Board of Family Medicine

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Once again, we consider how to effect practice change at the local and national levels. This issue includes several articles that relate to quality improvement. Some physician actions seem resistant to change, as do the underlying social determinants and processes that lead to what are thought to be avoidable hospitalizations, but we also find that concerted effort, along with standardized orders sets and other avenues, can make a difference. Sometimes, however, our attempts at change can lead to more distraction then efficacy. Here we include articles that place the quality issues in context, report interventions, and advance the types of specific knowledge that allow interventional trials. We also have several articles about cancer screening and follow-up, a subset of quality improvement. Quality ImprovementBaird 1 provides us with a fascinating historic and nuanced reflection of how and whether medical homes represent something new or otherwise different from former attempts at reform in family medicine, specifically managed care. In light of previous inflated expectations of the ways in which reforms can change medical care, he says, "no villains allowed."Information chaos is clearly one of the reasons that we struggle to improve quality to a desired level. Beasley and colleagues 2 provide a structure to consider the information chaos, the negative outcomes of the chaos, and some direction for future research. This construct also relates to our tonguein-cheek, yet provocative, selection from Baxley et al.3 who suggests that we sometimes act as if we have attention deficit disorder as we attempt to implement multiple concurrent Plan-Do-StudyAct practice improvement projects. It is a variant of a "quality improvement disorder." Therefore, some remedies are in order. However, the answer is not to just take a pill daily and hope it will go away. Hopefully, we can improve the quality of our quality improvement activities.In one major attempt to improve health care nationally, the Affordable Care Act mandates that the Centers for Medicaid and Medicare Services (CMS) implement a 10% payment increase for primary care. CMS criteria defining primary care are unfortunately currently inadequate to the task because they exclude many family physicians, particularly those in more rural settings or those who provide a broader range of services, as documented by research from the Robert Graham Center. 4 On to specific examples from the articles in this issue. We know that preventable hospitalizations vary by location, but just how easy are these to avert? Sumner et al 5 determined that the differences in preventable hospitalizations between the counties in Kentucky persisted over time. This suggests that underlying problems or processes are not readily changed, and that needed health care improvements will be relatively resistant to transformation.Another specific quality improvement item that seems resistant to change is the ordering of urine cultures for women with urinary tract infection symptoms. Obtaining urine culture...

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Diabetes and Cancer Screening Rates among Appalachian and Non-Appalachian Residents of Kentucky

Cited by 26 publications

References 27 publications

Where Can Colorectal Cancer Screening Interventions Have the Most Impact?

Where Can Colorectal Cancer Screening Interventions Have the Most Impact?

Correlates of Colorectal Cancer Screening Among Residents of Ohio Appalachia

Change, Lack of Change, and Creating Optimal Change Out of Chaos

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