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The Impact of Primary Care Resources on Colorectal Cancer Screening

Soban L, Yano EM, Parkerton PH, Lanto AB. The Impact of Primary Care Resources on Colorectal Cancer Screening. Paper presented at: VA QUERI National Meeting; 2003 Dec 10; Washington, DC.

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Objectives: While early evidence suggests that organizational factors influence delivery of colorectal cancer (CRC) screening, little is known about the contribution of the primary care practice structure, despite primary care's responsibility for screening performance. We examined the relationship of primary care (PC) resource sufficiency to CRC screening rates.Methods/Approach: We matched-and-merged facility-level data from two sources: (1) practice structure data from the VHA Primary Care Practices Survey (FY00) and (2) CRC screening rates from the VA External Peer Review Program (FY01). We derived scale scores from key informant ratings of the sufficiency of discrete PC resources using principal components analysis and performed bivariate and multivariate analyses to assess the relationship between resource sufficiency and CRC screening rates.Results/Findings: We identified three dimensions of PC resource sufficiency: space (alpha = 0.85), equipment (alpha = 0.81), and staff sufficiency (alpha = 0.69). We found that the degree of PC equipment sufficiency was significantly and positively associated with the delivery of CRC screening (r = .182). This relationship persisted after adjusting for facility size and academic affiliation. In contrast, ratings of space and staff sufficiency were not significantly associated with CRC screening. In facilities with above-mean equipment sufficiency scores, on average, 62% of patients were screened compared to 58% in facilities with scores below the mean (F = 6.70, p = .01).Implications: The sufficiency of primary care resources is predictive of CRC screening rates. Increased resources for primary care programs may improve CRC screening rates as well as the performance of other preventive service indicators. While VA policy shifted emphasis to primary care delivery with the 1994 VA Primary Care Directive, it is unclear whether competing initiatives over time have enhanced or undermined primary care resources. Given the relationship between PC resources sufficiency and prevention performance, more scrutiny regarding the unintended consequences of changing priorities is warranted.

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