Article Figures & Data
Figures
- Figure 1.
Systems of support to increase colorectal cancer screening (SOS) and patient-centered medical home timeline, August 2008 to November 2010.
- Figure 2.
Patient-centered medical home process map for medical assistant/nurse (MA) in-reach and outreach colorectal cancer screening (CRCS) processes.
Tables
- Table 1. Participant Characteristics By Assignment to Usual Care or Active Interventions and Exposure to a Patient-Centered Medical Home in Year 1 of the Systems of Support to Increase Colorectal Cancer Screening Trial
Characteristics of Exposure Group SOS Randomization Group By Duration of Exposure to a Medical Home (Months) SOS Usual Care SOS Intervention ≤4 >4 and <8 ≥8 ≤4 >4 and <8 ≥8 Participants 351 (30.1) 316 (27.1) 499 (42.8) 1048 (30.0) 935 (26.7) 1515 (43.3) Age at randomization (years) 50–64 299 (85.2) 265 (83.9) 428 (85.8) 895 (85.4) 784 (83.9) 1303 (86.0) 65–73 52 (14.8) 51 (16.1) 71 (14.2) 153 (14.6) 151 (16.2) 212 (14.0) Female sex 196 (55.8) 168 (53.2) 289 (57.9) 570 (54.4) 510 (54.6) 811 (53.5) Race/ethnicity Black 17 (4.9) 12 (3.8) 15 (3.1) 57 (5.5) 51 (5.5) 76 (5.0) Asian 28 (8.0) 14 (4.5) 22 (4.5) 56 (5.4) 47 (5.1) 70 (4.6) Hispanic 8 (2.3) 15 (4.9) 20 (4.1) 25 (2.4) 28 (3.0) 58 (3.8) Non-Hispanic white 282 (80.8) 261 (83.1) 407 (82.7) 845 (81.0) 738 (79.5) 1203 (79.6) Other 14 (4.0) 12 (3.8) 28 (5.7) 60 (5.8) 64 (6.9) 104 (6.9) General health Excellent/very good 221 (63.1) 184 (58.2) 317 (63.7) 676 (64.7) 565 (60.4) 972 (64.2) Good 105 (30.0) 100 (31.7) 133 (26.7) 303 (29.0) 298 (31.9) 452 (29.9) Fair/poor 24 (6.9) 32 (10.1) 48 (9.6) 66 (6.3) 72 (7.7) 90 (5.9) Married or living with a partner 253 (72.3) 224 (71.1) 360 (72.3) 772 (73.9) 704 (75.4) 1126 (74.3) Highest education High school graduate/GED or less 51 (14.5) 62 (19.7) 78 (15.7) 121 (11.6) 155 (16.6) 233 (15.4) Some college 112 (31.9) 107 (34.0) 149 (29.9) 315 (30.1) 322 (34.5) 462 (30.5) Bachelor's degree or higher 188 (53.6) 146 (46.4) 271 (54.4) 611 (58.4) 457 (48.9) 820 (54.1) Smoking status Current 36 (10.4) 56 (18.2) 62 (12.7) 117 (11.4) 99 (10.8) 175 (11.8) Former 92 (26.5) 80 (26.0) 137 (28.1) 299 (29.1) 262 (28.5) 426 (28.8) Never 219 (63.1) 172 (55.8) 288 (59.1) 611 (59.5) 557 (60.7) 880 (59.4) Never tested for CRC (before randomization) 146 (41.6) 153 (48.4) 240 (48.1) 438 (41.8) 433 (46.3) 750 (49.5) First-degree relative with CRC 18 (5.2) 17 (5.5) 20 (4.1) 57 (5.5) 45 (4.9) 58 (3.9) Data collection occurred between 2008 and 2009. Data are n (%).
CRC, colorectal cancer; SOS, Systems of Support to Increase Colorectal Cancer Screening Trial.
- Table 2. Colorectal Cancer Screening Uptake* among Patients Receiving Usual Care in the Systems of Support to Increase Colorectal Cancer Screening Trial, by Exposure to a Patient-Centered Medical Home
Usual Care Only Duration of Exposure to Medical Home (months) ≤4 (n = 351) >4 and <8 (n = 316) ≥8 (n = 499) Primary outcome Any CRCS* Unadjusted percent (95% CI) 36.8 (31.9–41.9) 34.8 (29.7–40.2) 44.9 (40.6–49.3) Adjusted RR† (95% CI) 1.00 (Referent) 0.99 (0.81–1.18) 1.29 (1.15–1.42) Adjusted difference‡ (95% CI) Referent −0.2 (−6.9 to 6.5) 10.1 (5.7–14.6) Secondary outcomes Any fecal test§ Unadjusted percentage (95% CI) 21.1 (17.1–25.7) 20.6 (16.5–25.4) 32.7 (28.7–36.9) Adjusted RR† (95% CI) 1.00 (Referent) 0.99 (0.64–1.35) 1.58 (1.22–1.94) Adjusted difference‡ (95% CI) Referent −0.1 (−7.6 to 7.3) 12.1 (5.9–18.2) Any endoscopy Unadjusted percentage (95% CI) 21.4 (17.4–26.0) 20.6 (16.5–25.4) 18.2 (15.1–21.9) Adjusted RR† (95% CI) 1.00 (Referent) 1.03 (0.77–1.29) 0.95 (0.73–1.18) Adjusted difference‡ (95% CI) Referent 0.6 (−4.5 to 5.8) −0.9 (−5.4 to 3.6) ↵* Any colorectal cancer screening (CRCS) test included completion of fecal occult blood tests, flexible sigmoidoscopy, or colonoscopy during year 1 of the Systems of Support to Increase Colorectal Cancer Screening Trial (SOS). All patients were overdue for CRCS.
↵† Relative risk (RR) of screening in the exposure group relative to the group with ≤4 months of exposure to a patient-centered medical home (PCMH), adjusted for age, sex, race, education, and prior CRCS.
↵‡ Adjusted difference is the percentage screened in the exposure group minus the percentage screened in group with ≤4 months of exposure to a PCMH, adjusted for age, sex, race, education, and prior CRCS.
↵§ Hemoccult SENSA.
CI, confidence interval.
- Table 3. Colorectal Cancer Screening Test Completion* in the Usual Care and Intervention Arms By Exposure to a Patient-Centered Medical Home
Duration of Exposure to PCMH By Treatment Arm ≤4 Months >4 and <8 Months ≥8 Months UC (n = 351) Intervention (n = 1048) UC (n = 316) Intervention (n = 935) UC (n = 499) Intervention (n = 1515) Primary outcome Any CRCS Unadjusted percentage (95% CI) 36.8 (31.9–41.9) 70.7 (67.9–73.4) 34.8 (29.7–40.2) 69.3 (66.3–72.2) 44.9 (40.6–49.3) 66.1 (63.6–68.4) SOS intervention effect Adjusted RR† (95% CI) 1.0 (Referent) 1.98 (1.79–2.17) 1.0 (Referent) 1.96 (1.62–3.42) 1.0 (Referent) 1.49 (1.34–1.63) Adjusted difference‡ (95% CI) Referent 34.4 (30.6–38.2) Referent 34.1 (27.4–40.8) Referent 21.9 (17.4–26.4) Secondary outcomes Any fecal test§ Unadjusted percentage (95% CI) 21.1 (17.1–25.7) 63.8 (60.9–66.7) 20.6 (16.5–25.4) 61.8 (58.7–64.9) 32.7 (28.7–36.9) 58.0 (55.4–60.4) SOS intervention effect Adjusted RR† (95% CI) 1.0 (Referent) 3.05 (2.48–3.62) 1.0 (Referent) 2.98 (2.20–3.76) 1.0 (Referent) 1.80 (1.51–2.09) Adjusted difference‡ (95% CI) Referent 42.2 (37.6–46.9) Referent 41.2 (36.0–46.3) Referent 26.2 (20.9–31.5) Any endoscopy Unadjusted percentage (95% CI) 21.4 (17.4–26.0) 20.7 (18.4–23.3) 20.6 (16.5–25.4) 19.4 (16.9–22.0) 18.2 (15.1–21.9) 17.0 (15.2–19.0) SOS intervention effect Adjusted RR† (95% CI) 1.0 (Referent) 1.00 (0.86–1.14) 1.0 (Referent) 0.92 (0.64–1.21) 1.0 (Referent) 0.93 (0.79–1.08) Adjusted difference‡ (95% CI) Referent 0.0 (−2.8 to 2.8) Referent −1.6 (−8.0 to 4.8) Referent −1.2 (−4.2 to 1.7) Interaction P value to test for differences in Systems of Support to Increase Colorectal Cancer Screening Trial (SOS) intervention effects by level of exposure to a patient-centered medical home: P < .01 for any colorectal cancer screening (CRCS) and fecal test; P = .49 for any endoscopy.
↵* CRCS tests included completion of fecal occult blood tests, flexible sigmoidoscopy, or colonoscopy during year one of the SOS trial. All patients were overdue for CRCS.
↵† RR = Relative Risk of CRCS testing in SOS intervention group relative to SOS usual care group, adjusted for age, sex, race, education, and prior testing.
↵‡ Adjusted difference = percent tested in SOS intervention group relative to SOS usual care group, adjusted for age, sex, race, education, and prior CRC tests.
↵§ Hemoccult SENSA.
CI, confidence interval; PCMH, patient-centered medical home; UC, usual care.
