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PRIMARY CARE PRACTICE AUTONOMY INFLUENCES COLORECTAL CANCER SCREENING

PRIMARY CARE PRACTICE AUTONOMY INFLUENCES COLORECTAL CANCER SCREENING. Patricia H. Parkerton, PhD MPH Elizabeth M. Yano, PhD MSPH Lynn M. Soban, MPH BSN David A. Etzioni, MD MSHS. Supported by. Department of Veterans’ Affairs (VA) HSR&D : Health Services Research and

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PRIMARY CARE PRACTICE AUTONOMY INFLUENCES COLORECTAL CANCER SCREENING

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  1. PRIMARY CARE PRACTICEAUTONOMY INFLUENCESCOLORECTAL CANCER SCREENING Patricia H. Parkerton, PhD MPH Elizabeth M. Yano, PhD MSPH Lynn M. Soban, MPH BSN David A. Etzioni, MD MSHS

  2. Supported by • Department of Veterans’ Affairs (VA) • HSR&D: Health Services Research and Development • QUERI: Quality Enhancement Research Initiative, Colorectal Cancer

  3. Objectives • Determine sources of CRC screening variation • Determine role of practice and clinical leader autonomy

  4. Colorectal Cancer (CRC) Screening Modalities Chart documentation of: • FOBT in last year, • Flexible sigmoidoscopy in last 5 years or • Colonoscopy in last 10 years

  5. CRC Screening Rates: CDC 2001 • #2 cause of cancer deaths (57,000) • Early detection reduces mortality • National average: 53% • Variation by State: 42--65%

  6. CRC Screening at the VA Department of Veterans’ Affairs • Mean 60% • Varies by • Region: 55% to 62% • Facility: 25% to 88% • Lowest preventive measure at VA medical centers

  7. Facility Population • All VA primary-care sites • Serving >4,000 primary care patients • Delivering >20,000 primary care visits • N=235 • Response 219 sites (93%)

  8. Leader Autonomy onColorectal Cancer Screening

  9. Control Variables

  10. Study Variables

  11. Data Sources • CRC screening rates from the • External Peer Review Program of • 71,000 charts (2001) • Organizational structures and processes from the • Primary Care Practices Survey (2000)

  12. Primary Care Leader Autonomy Scale *

  13. CRC Screening and Autonomy Correlations

  14. Regression Results: Autonomy on CRC Screening

  15. Regression Results: Full Model

  16. Conclusions • Primary care practice leader autonomy was associated with higher CRC screening • No other measure altered this relationship: academic affiliation, quality improvement, or size

  17. Limitations • Facilities within one health system • 1999-2000 data in changing times • Captures perceptions not actual activity • Leader characteristics are unmeasured

  18. Implications/Potential Impact: • Increasing Clinical Leader Autonomy over practice arrangements may • enhance receipt of preventive services • result in earlier detection of cancer • lower mortality • Value of Autonomy relative to needs for consistency needs further exploration

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