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Influence of Primary Care Practice Autonomy on Colorectal Cancer Screening

Parkerton PH, Yano EM, Soban L, Etzioni DA. Influence of Primary Care Practice Autonomy on Colorectal Cancer Screening. Paper presented at: VA QUERI National Meeting; 2003 Dec 10; Washington, DC.

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Objectives: Although colorectal cancer screening (CRCS) rates within VHA are well above national averages, there is substantial variability in the delivery of this service and they are among the lowest of all preventive services for which performance is measured at the VHA medical center level. Because links between authority over clinical care arrangements and responsibility for outcomes might influence care, this study examines the relationship between primary care practice autonomy and CRCS rates as part of a QUERI Colorectal Cancer affiliated project to measure determinants of current practice.Methods/Approach: To measure the variation in CRCS across facilities and influence of primary care practice organization the data was merged from the External Peer Review Program (CRCS rates) and the VA Primary Care Practices Survey (organizational structures and processes). We used Principal Components Analysis to create a scale of practice autonomy (k = 4, alpha = .89) comprised of items regarding authority over establishing clinical procedures, new primary care components and guideline-concordant care. Documented evidence of CRC screening was defined as 1) FOBT in last year, 2) flexible sigmoidoscopy in last 5 years or 3) colonoscopy in last 10 years. Bivariate and multivariate analyses were performed.Results/Findings: CRCS rates (2001) vary from 55% to 62% by region and from 25% to 88% by facility. The degree of primary care practice autonomy was significantly and positively associated with the delivery of CRCS, even after adjusting for size and academic affiliation.Implications: Colorectal cancer is the second greatest cause of cancer mortality and early detection reduces mortality. Increasing primary care authority over clinical arrangements related to screening may enhance Veterans' receipt of preventive services. Measurement of practice characteristics is vital to achievement of improved care.

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