TY - JOUR
T1 - Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics
T2 - A Multilevel Analysis
AU - Wang, Hongmei
AU - Qiu, Fang
AU - Gregg, Abbey
AU - Chen, Baojiang
AU - Kim, Jungyoon
AU - Young, Lufei
AU - Wan, Neng
AU - Chen, Li Wu
N1 - Publisher Copyright:
© 2017 National Rural Health Association
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Purpose: This study examines multilevel factors related to colorectal cancer (CRC) screening in a rural Accountable Care Organization (ACO) setting. Methods: The study used electronic medical record data from 8 rural ACO clinics in Nebraska. The final sample included 15,866 average-risk patients aged 50-75 years who visited participating clinics at least once from June 2014 to May 2015. Logistic regression was conducted to examine simultaneous effects of patient, provider, and county characteristics on CRC screening after accounting for provider-county-level correlation using a generalized estimating equations method. Findings: The results indicated that patients aged 65 years and older, non-Hispanic white, whose preferred language was English, who had insurance, who had a wellness visit in the past year, and who had chronic conditions were more likely to be up-to-date on CRC screening. Patients were also more likely to be up-to-date when their primary care provider was a female medical doctor who was aware of clinic CRC screening protocols or who manually checked patient CRC screening status during the patient visit. Patients in a county with no gastroenterologist, a high poverty rate, and low insurance coverage were less likely to be up-to-date on CRC screening. Conclusions: A variety of patient, provider, and county characteristics were associated with CRC screening. Effective strategies to promote CRC screening should address multilevel factors, including: targeting patients with identified individual barriers, modifying physician and clinical practices, and focusing on communities with low socioeconomic status or low levels of medical resources.
AB - Purpose: This study examines multilevel factors related to colorectal cancer (CRC) screening in a rural Accountable Care Organization (ACO) setting. Methods: The study used electronic medical record data from 8 rural ACO clinics in Nebraska. The final sample included 15,866 average-risk patients aged 50-75 years who visited participating clinics at least once from June 2014 to May 2015. Logistic regression was conducted to examine simultaneous effects of patient, provider, and county characteristics on CRC screening after accounting for provider-county-level correlation using a generalized estimating equations method. Findings: The results indicated that patients aged 65 years and older, non-Hispanic white, whose preferred language was English, who had insurance, who had a wellness visit in the past year, and who had chronic conditions were more likely to be up-to-date on CRC screening. Patients were also more likely to be up-to-date when their primary care provider was a female medical doctor who was aware of clinic CRC screening protocols or who manually checked patient CRC screening status during the patient visit. Patients in a county with no gastroenterologist, a high poverty rate, and low insurance coverage were less likely to be up-to-date on CRC screening. Conclusions: A variety of patient, provider, and county characteristics were associated with CRC screening. Effective strategies to promote CRC screening should address multilevel factors, including: targeting patients with identified individual barriers, modifying physician and clinical practices, and focusing on communities with low socioeconomic status or low levels of medical resources.
KW - Accountable Care Organizations
KW - barriers
KW - colorectal cancer screening
KW - multilevel analysis
KW - rural patients
UR - http://www.scopus.com/inward/record.url?scp=85021901457&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021901457&partnerID=8YFLogxK
U2 - 10.1111/jrh.12248
DO - 10.1111/jrh.12248
M3 - Article
C2 - 28686787
AN - SCOPUS:85021901457
SN - 0890-765X
VL - 34
SP - 202
EP - 212
JO - Journal of Rural Health
JF - Journal of Rural Health
IS - 2
ER -