Predictors of Colorectal Cancer Screening: Does Rurality Play a Role?

Ojinnaka, Chinedum O.; Choi, Yong Won; Kum, Hye‐Chung; Bolin, Jane N.

doi:10.1111/jrh.12104

Cited by 37 publications

(39 citation statements)

References 40 publications

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“…MMC patients also are more likely to encounter barriers to screenings, such as low health literacy and limited English language competency, which can affect screening uptake. 18,19 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Dacus

Wagner

Collins

et al. 2018

Cancer

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BACKGROUND: The objective of this study was to evaluate an ongoing initiative to improve colorectal cancer (CRC) screening uptake in the New York State (NYS) Medicaid managed care population. METHODS: Patients aged 50 to 75 years who were not up to date with CRC screening and resided in 2 NYS regions were randomly assigned to 1 of 3 cohorts: no mailed reminder, mailed reminder, and mailed reminder + incentive (in the form of a $25 cash card). Screening prevalence and the costs of the intervention were summarized. RESULTS: In total, 7123 individuals in the Adirondack Region and 10,943 in the Central Region (including the Syracuse metropolitan area) were included. Screening prevalence in the Adirondack Region was 7.2% in the mailed reminder + incentive cohort, 7.0% in the mailed reminder cohort, and 5.8% in the no mailed reminder cohort. In the Central Region, screening prevalence was 7.2% in the mailed reminder cohort, 6.9% in the mailed reminder + incentive cohort, and 6.5% in the no mailed reminder cohort. The cost of implementing interventions in the Central Region was approximately 53% lower than in the Adirondack Region. CONCLUSIONS: Screening uptake was low and did not differ significantly across the 2 regions or within the 3 cohorts. The incentive payment and mailed reminder did not appear to be effective in increasing CRC screening. The total cost of implementation was lower in the Central Region because of efficiencies generated from lessons learned during the first round of implementation in the Adirondack Region. More varied multicomponent interventions may be required to facilitate the completion of CRC screening among Medicaid beneficiaries.

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“…MMC patients also are more likely to encounter barriers to screenings, such as low health literacy and limited English language competency, which can affect screening uptake. 18,19 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Dacus

Wagner

Collins

et al. 2018

Cancer

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“…Importantly, a recent systematic review identified a notable lack of studies assessing who provides colonoscopy care in rural areas. 16 Lower rates of colorectal cancer screening in rural areas 17,18 suggest a need for increased provision of colonoscopy care in these regions.…”

Section: Discussionmentioning

confidence: 99%

“…15 In addition, residents of rural areas have been shown to have lower screening rates than urban residents [16][17][18] and a higher proportion of their colonoscopy procedures done by general surgeons. 15 Furthermore, the nature of the 2 professions differs and allows for varied roles in the delivery of endoscopy.…”

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confidence: 99%

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study

et al. 2018

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Background: Screening colonoscopy for the detection of colorectal carcinoma is provided by several specialties. Few studies have assessed geographic variation in the delivery of this care. Our objective was to investigate how geographic and socioeconomic factors affect who provides screening colonoscopy in Canada. Methods:This was a population-based cohort of all screening colonoscopy procedures performed at publicly funded Canadian health care facilities (excluding those in Quebec) between April 2008 and March 2015. The main outcome of interest was the proportion of colonoscopy procedures performed by surgeons versus gastroenterologists at the neighbourhood level. Predictors of interest included socioeconomic and geographic variables. We used spatial analysis to evaluate significant clustering of practitioner services and multinomial logistic regression to model predictors. Results:We identified 658 113 screening colonoscopy procedures performed by 1886 providers (1169 surgeons and 717 gastroenterologists) over the study period, of which 353 165 (53.7%) were performed by surgeons. A total of 24.2% of neighbourhoods were located within clusters predominantly served by gastroenterologists, and 19.5% were within surgeon clusters; the remainder were in mixed clusters. Rural neighbourhoods had a significantly increased relative risk of being within a surgeon cluster (relative risk [RR] 5.38, 95% confidence interval [CI] 3.48-8.01) compared to mixed clusters and nearly 100 times higher relative risk of being in a surgeon cluster compared to gastroenterologist clusters (RR 98.95,. Neighbourhoods with the highest socioeconomic status were 1.74 (95% CI 1.14-2.56) times likelier to be in gastroenterologist clusters than in mixed clusters.Interpretation: Surgeons provide a large proportion of colonoscopy procedures in Canada and are essential for access to care, particularly in rural regions. Most Canadians are served relatively equally by surgeons and gastroenterologists. This emphasizes the importance of both specialties to the delivery of colonoscopy care across the country. AbstractResearch OPEN CMAJ OPEN, 6(1) E127

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“…The US Preventive Services Task Force recommends that adults aged between 50 and 75 years have a CRC screening, including fecal occult blood testing annually, sigmoidoscopy every 5 years, or colonoscopy every 10 years 2 . Despite the significant health benefits of routine CRC screening [2][3][4][5][6][7] , previous studies well documented the disparities between urban and rural communities in CRC screenings [8][9][10][11] . Primary care providers (PCPs) in rural clinics can play a critical role in improving CRC screening, by educating patients, providing accurate information, and recommending screening 12 .…”

Section: Introductionmentioning

confidence: 99%

Promoting colorectal cancer screening through a new model of delivering rural primary care in the USA: a qualitative study

Kim

Young

Bekmuratova

et al. 2017

Rural Remote Health

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A B S T R A C TIntroduction: Despite the known benefits of colorectal cancer (CRC) screening, rural areas have consistently reported lower screening rates than their urban counterparts. Alternative healthcare delivery models, such as accountable care organizations (ACOs), have the potential to increase CRC rates through collaboration among healthcare providers with the aim of improving quality and decreasing cost. However, researchers have not sufficiently explored how this innovative model could influence the promotion of cancer screening. The purpose of the study was to explore the mechanism of how CRC screening can be promoted in ACO-participating rural primary care clinics. Methods: The study collected qualitative data from in-depth interviews with 21 healthcare professionals employed in ACOparticipating primary care clinics in rural Nebraska. Participants were asked about their views on opportunities and challenges to promote CRC screening in an ACO context. Data were analyzed using a grounded theory approach. Results: The study found that the new healthcare delivery model can offer opportunities to promote cancer screening in rural areas through enhanced electronic health record use, information sharing and collaborative learning within ACO networks, use of standardized quality measures and performance feedback, a shift to preventive/comprehensive care, adoption of team-based care, © J Kim, L Young, S Bekmuratova, DJ Schober, H Wang, S Roy, SS Bhuyan, A Schumaker, L-W Chen, 2017. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2 and empowered care coordinators. The perceived challenges were found in financial instability, increased staff workload, lack of provider training/education, and lack of resources in rural areas.Conclusions: This study found that the innovative care delivery model, ACO, could provide a well-designed platform for promoting CRC screening in rural areas, if sustainable resources (eg finance, health providers, and education) are provided. This study provides 'practical' information to identify effective and sustainable intervention programs to promote preventive screening. Further efforts are needed to facilitate delivery system reforms in rural primary care, such as improving performance evaluation measures and methods.Key words: accountable care organizations, colorectal cancer screening, delivery system innovation, primary care, rural health services, USA. IntroductionColorectal cancer (CRC) is the second-leading cause of death in the USA 1. The US Preventive Services Task Force recommends that adults aged between 50 and 75 years have a CRC screening, including fecal occult blood testing annually, sigmoidoscopy every 5 years, or colonoscopy every 10 years 2 . Despite the significant health benefits of routine CRC screening [2][3][4][5][6][7] , previous studies well documented the disparities between urban and rural communities in CRC screenings [8][9][10][11] . Primary care providers (PCPs) in rural clinics can play a critical role i...

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Predictors of Colorectal Cancer Screening: Does Rurality Play a Role?

Abstract: Effective development and implementation of strategies to improve screening rates should aim at improving access to health care, taking into account demographic characteristics such as rural versus urban residence.

Cited by 37 publications

References 40 publications

Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study

Promoting colorectal cancer screening through a new model of delivering rural primary care in the USA: a qualitative study

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