Article Figures & Data
Tables
Patient Characteristics Exemplars (n=1188) Non-exemplars (n=2408) Significance p-value No. % No. % Sex Female 738 62.3 1470 61.1 NS Missing 3 0.3 2 0.1 NS Age (mean years) 64.0 4.8 63.2 3.4 .015 Race White 604 50.8 940 39.0 <.001 Black 173 14.6 244 10.1 <.001 Native American 116 9.8 171 7.1 <.007 Asian Pacific 10 0.8 177 7.4 <.001 Missing 285 24.0 876 36.4 <.001 Payor Commercial 453 38.1 1009 41.9 .03 Medicare 453 38.1 928 38.5 NS Medicaid 91 7.7 141 5.9 .04 Indian Health Service 94 7.9 115 4.8 <.001 Self-pay 26 2.2 109 4.5 <.001 Missing 71 6.0 106 4.4 NS Medical Problems Cancer 4.3 51 3.0 72 .029 COPD 9.3 110 10.8 259 NS Dementia 1.3 16 1.0 25 NS Depression 17.5 208 15.0 361 NS Diabetes 24.7 293 24.6 593 NS Heart disease 16.6 197 15.5 373 NS Hypertension 56.8 675 58.2 1402 NS Renal failure 2.4 28 1.1 27 .006 Stroke 2.4 29 2.3 55 NS Preventive services* Influenza vaccination 364 45.3 772 42.1 NS Cholesterol screening 1066 90.3 1998 83.9 <.001 Mammogram 496 67.4 726 49.8 <.001 ↵* Excludes services refused or not indicated.
COPD, chronic obstructive pulmonary disease; NS, not statistically significant.
Screening Exemplar Patients (n=1188) Nonexemplar Patients (n=2408) P Recommended screening period (years) % No. Total no.* % No. Total no.* 1 54.6 572 1047 32.7 732 2238 <.001 5 57.0 470 829 34.9 698 1998 <.001 10 23.8 72 302 18.9 184 972 .063 Documented screening method Fecal occult blood test 205 17.3 259 10.8 <.001 Colonoscopy 456 38.4 448 18.6 <.001 Flexible sigmoidoscopy 29 2.4 31 1.3 .018 Double-contrast barium enema 24 2.0 20 0.8 .003 Any screening method 652 54.9 682 28.3 <.001 ↵* Patients appropriate for screening during each screening period minus those missing.
- Table 3. Rates of Colorectal Cancer Screening in Exemplars and Nonexemplars According to the Presence of Tracking Method
Tracking Method Exemplar Patients (n=1188) Non-exemplar Patients (n=2408) P value Present Used Subtotal Screened Subtotal Screened Yes Yes (619 (56.9) (359 (58.1) (1211 (52.2) (338 (27.9) <.001 Yes No 226 (20.8) 97 (42.9) 313 (13.5) 79 (25.2) <.001 No — 315 (22.4) 171 (54.3) 858 (34.3) 250 (29.1) <.001 Data shown as n (%).
Insurance Coverage Patients P value* Screened (n) Total (n) % Nonexemplars Medicare or commercial 588 1937 30.4 Medicaid or IHS 48 256 19.1 <.001 Self-pay 14 109 12.8 Exemplars Medicare or commercial 536 906 59.2 Medicaid or IHS 72 185 38.9 <.001 Self-pay 10 26 38.5 IHS, Indian Health Service.
↵* P values for exemplars versus nonexemplars; comparisons were (1) Medicare or commercial, P < .001; (2) Medicaid or IHS, P < .001; (3) self-pay, P=.004; and (4) total, P < .001.
Screening Method Exemplars Nonexemplars Met Criteria (n) Total (n) % Met Criteria (n) Total (n) % Fecal occult blood test Recommended 10 10 100 16 18 89 Results* 9 10 90 8 16 50 Flexible sigmoidoscopy Recommendation 8 9 89 4 9 44 Results* 3 7 43 3 9 33 Double-contrast barium enema Recommendation 5 7 71 2 6 33 Results* 5 7 71 2 6 33 Colonoscopy Recommendation 181 231 78 176 218 81 Results* 54 155 35 75 167 45 ↵* Patients were excluded from analysis if there was inadequate time for follow-up.
Begin with a strong commitment to preventive services delivery.
Use any visit to recommend colorectal cancer screening.
Use paper or electronic health record to prompt screening recommendation.
Offer a brief personal recommendation bundled with other preventive health services.
Recommend colonoscopy or fecal occult blood testing (if colonoscopy is declined or not affordable).
Emphasize benefits of early detection and avoiding regret.
Determine barriers and use anecdotes to overcome.
If colorectal cancer screening is declined, demonstrate concern and repeat recommendation during the next visit.
Off-load explaining the details of the screening process to office staff.
Cultivate a relationship with endoscopist(s) who provide quality service and communication, and outsource responsibility for the details of endoscopy process.
