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J Gen Intern Med. 2016 Nov;31(11):1323-1330. doi: 10.1007/s11606-016-3792-1. Epub 2016 Jul 13.

Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System.

Author information

1
Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
2
Division of Research, Kaiser Permanente, Oakland, CA, USA.
3
Research & Evaluation, Kaiser Permanente, Pasadena, CA, USA.
4
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
5
Erasmus University Medical Center (Erasmus MC), Rotterdam, Netherlands.
6
Division of Gastroenterology, Howard University College of Medicine, Washington, DC, USA.
7
Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA.
8
Emory University, Atlanta, GA, USA.
9
Harvard Medical School, Boston, MA, USA.
10
Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Gates 2 Pavilion, Philadelphia, PA, 19104, USA. chyke.doubeni@uphs.upenn.edu.

Abstract

BACKGROUND:

Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known.

OBJECTIVE:

To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program.

DESIGN:

Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004-2013).

SUBJECTS:

A total of 868,934 screen-eligible individuals 51-74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004-2006), 654,633 during the first 3 years after implementation (2007-2009), and 665,268 in the period from 4 to 7 years (2010-2013) after program implementation.

INTERVENTION:

A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits.

MAIN MEASURES:

Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races.

KEY RESULTS:

From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02-1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96-0.97). There were also substantial improvements in timely follow-up of positive screening results.

CONCLUSIONS:

In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.

KEYWORDS:

cancer screening; colorectal cancer; health care delivery; population health; race & ethnicity

PMID:
27412426
PMCID:
PMC5071288
DOI:
10.1007/s11606-016-3792-1
[Indexed for MEDLINE]
Free PMC Article

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