Article Figures & Data
Figures
- Figure 1.
CONSORT diagram depicting the flow of study practice clusters and patients through randomization, intervention, and outcome analysis.
- Figure 2.
Diagram depicting the workflow of intervention and comparison groups. Augmented usual care with primary care provider (PCP) input (intervention) is indicated by solid lines; augmented usual care without PCP input (comparison) is indicated by dotted lines.
- Figure 3.
Adjusted rate differences and 95% confidence intervals for all cancer screenings combined in intervention and comparison groups in patient and practice subgroups. Rate differences compare patients in the intervention and comparison groups, controlling for age, ethnicity, insurance status, primary language, time since last visit to practice, patient–physician linkage, and sex while accounting for clustering by primary care physician or practice in a mixed effects model. For each subgroup analysis, the analogous variable was removed from the model if necessary. CRC, colorectal cancer.
Tables
- Table 1. Practice, Physician, and Patient Characteristics among Intervention and Comparison Practices
Characteristics Intervention (n = 51,071) Comparison (n = 52,799) P Value Practice/physician characteristics Practice sites (n) 9 9 Community health center 3 3 Physicians per practice, n (median) 92 (9) 77 (9) Mean age, years (SD) 49.7 (10.1) 47.5 (10.0) .14 Sex 50 (54.4) 45 (58.4) .59 Years since medical school graduation, mean (SD) 21.8 (10.4) 19.6 (10.1) .15 Years in primary care network, mean (SD) 15.8 (10.9) 13.1 (10.4) .09 Patient characteristics Mean age, years (SD) 51.5 (14.3) 48.5 (14.8) <.001 Female sex 37,906 (74.2) 40,568 (76.8) <.001 Ethnicity <.001 African-American 2920 (5.7) 3319 (6.3) Asian 2724 (5.3) 3473 (6.6) Hispanic 3865 (7.6) 5964 (11.3) Other/unknown 1256 (2.5) 1384 (2.6) Non-Hispanic white 40,306 (78.9) 38,659 (73.2) Insurance status <.001 Commercial 35,665 (69.8) 37,895 (71.8) Medicaid 4602 (9.0) 5486 (10.4) Medicare 9058 (17.7) 7437 (14.1) No insurance, self-pay/free 1746 (3.4) 1981 (3.8) Primary language spoken, English 46,560 (91.2) 46,478 (88.0) <.001 Patient-physician connectedness status <.001 Physician-connected 42,449 (83.1) 42,132 (79.8) Practice-connected 8622 (16.9) 10,667 (20.2) Time since last practice visit (months) <.001 <6 31,439 (61.6) 30,658 (58.1) >6–12 10,206 (20.0) 10,473 (19.8) >12 6668 (13.1) 8663 (16.4) New patient 2758 (5.4) 3005 (5.7) Community health center practice type 7008 (13.7) 8935 (16.9) <.001 Baseline screening rates, n/N (%) Breast cancer 18,389/22,425 (82.0) 16,556/20,439 (81.0) .01 Cervical cancer 23,031/27,748 (83.0) 26,847/31,961 (84.0) .001 Colorectal cancer 20,642/26,843 (76.9) 17,431/23,556 (74.0) <.001 Data are n (%) unless otherwise indicated. SD, standard deviation.
- Table 2. Cancer Screening Rates Among Intervention and Comparison Group Patients Eligible for at Least 1 Cancer Screening Test During the Study Period
Cancer Screening Average Cancer Screening Test Completion Rates Unadjusted Adjusted* Intervention Comparison P Value No. Rate (%) No. Rate (%) Intervention (%) Comparison (%) P Value All eligible cancers 51,071 81.6 52,799 81.4 .90 81.6 81.4 .84 Breast 24,602 82.8 22,351 82.7 .93 82.7 82.7 .96 Cervical 32,121 84.2 35,889 84.7 .72 84.1 84.7 .60 Colorectal 30,353 77.9 26,756 76.2 .33 77.8 76.2 .33 ↵* Adjusted rates and P values obtained from mixed effects models comparing intervention and control groups controlling for patient age, ethnicity, insurance status, primary language, time since last visit to practice, patient–physician linkage, and sex (for colorectal cancer and all screenings combined) while accounting for clustering by primary care physician or practice in a mixed effects model.
- Table 3. Cancer Screening Rates among Eligible Intervention and Comparison Group Patients Overdue for at Least 1 Cancer Screening Test During the Study Period
Average Cancer Screening Test Completion Rates Unadjusted Adjusted* Intervention Comparison P Value No. Rate (%) No. Rate (%) Intervention (%) Comparison (%) P Value All eligible cancers 18,873 18.3 19,201 17.8 .59 18.8% 17.8% .28 Breast 6927 23.2 6486 24.0 .52 23.7% 24.0% .80 Cervical 8919 23.3 9640 21.1 .23 23.4% 21.1% .14 Colorectal 8135 8.7 7740 9.3 .29 9.0% 9.3% .53 Practices in top tertile of TopCare practice delegate use All eligible cancers 6276 22.3 7678 16.9 .003 20.8 16.9 <.001 Breast 2503 26.5 2811 23.1 .06 26.4 23.1 .06 Cervical 3166 28.4 3599 18.7 .002 28.2 18.7 <.001 Colorectal 2279 9.3 3262 9.4 .92 9.7 9.4 .79 ↵* Adjusted rates and P values obtained from mixed effects models comparing intervention and control groups controlling for patient age, ethnicity, insurance status, primary language, time since last visit to practice, patient–physician linkage, and sex (for colorectal cancer and all screenings combined) while accounting for clustering by primary care physician or practice in a mixed effects model.
