Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics

A Multilevel Analysis

Hongmei Wang, Fang Qiu, Abbey Gregg, Baojiang Chen, Jungyoon Kim, Lufei Young, Neng Wan, Li Wu Chen

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)202-212
Number of pages11
JournalJournal of Rural Health
Volume34
Issue number2
DOIs
StatePublished - Mar 1 2018

Fingerprint

Accountable Care Organizations
Multilevel Analysis
Early Detection of Cancer
Colorectal Neoplasms
Insurance Coverage
Electronic Health Records
Poverty
Insurance
Social Class
Primary Health Care
Language
Logistic Models

Keywords

  • Accountable Care Organizations
  • barriers
  • colorectal cancer screening
  • multilevel analysis
  • rural patients

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics : A Multilevel Analysis. / Wang, Hongmei; Qiu, Fang; Gregg, Abbey; Chen, Baojiang; Kim, Jungyoon; Young, Lufei; Wan, Neng; Chen, Li Wu.

In: Journal of Rural Health, Vol. 34, No. 2, 01.03.2018, p. 202-212.

Research output: Contribution to journalArticle

Wang, Hongmei ; Qiu, Fang ; Gregg, Abbey ; Chen, Baojiang ; Kim, Jungyoon ; Young, Lufei ; Wan, Neng ; Chen, Li Wu. / Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics : A Multilevel Analysis. In: Journal of Rural Health. 2018 ; Vol. 34, No. 2. pp. 202-212.
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abstract = "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.",
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