Organizational Factors Affecting the Likelihood of Cancer Screening Among VA Patients.

Chou AF, Rose DE, Farmer M, Canelo I, Yano EM. Organizational Factors Affecting the Likelihood of Cancer Screening Among VA Patients. Medical care. 2015 Dec 1; 53(12):1040-9.

Related HSR&D Project(s)

• RCS 05-195 – Research Career Scientist Award
• IIR 06-087 – VA's Quality Transformation: Lessons for Evidence-Based Management
• MRC 05-093 – VHA Practice System Assessment Survey

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Abstract:

BACKGROUND: Preventive service delivery, including cancer screenings, continues to pose a challenge to quality improvement efforts. Although many studies have focused on person-level characteristics associated with screening, less is known about organizational influences on cancer screening. OBJECTIVES: This study aims to understand the association between organizational factors and adherence to cancer screenings. METHODS: This study employed a cross-sectional design using organizational-level, patient-level, and area-level data. Dependent variables included breast, cervical, and colorectal cancer screening. Organizational factors describing resource sufficiency were constructed using factor analyses from a survey of 250 Veterans Affairs primary care directors. We conducted random-effects logistic regression analyses, modeling cancer screening as a function of organizational factors, controlling for patient-level and area-level factors. RESULTS: Overall, 87% of the patients received mammograms, 92% received cervical and 78% had colorectal screening. Quality improvement orientation increased the odds of cervical [odds ratio (OR): 1.27; 95% confidence interval (CI), 1.03-1.57] and colorectal cancer screening (OR: 1.10; 95% CI, 1.00-1.20). Authority in determining primary care components increased the odds of mammography screening (OR: 1.23; 95% CI, 1.03-1.51). Sufficiency in clinical staffing increased the odds of mammography and cervical cancer screenings. Several patient-level factors, serving as control variables, were associated with achievement of screenings. CONCLUSIONS: Resource sufficiency led to increased odds of screening possibly because they promote excellence in patient care by conveying organizational goals and facilitate goal achievement with resources. Complementary to patient-level factors, our findings identified organizational processes associated with better performance, which offer concrete strategies in which facilities can evaluate their capabilities to implement best practices to foster and sustain a culture of quality care.