Multi-component interventions and change in screening rates in primary care clinics in the Colorectal Cancer Control Program

• Type of Material: Article
• Authors: Krishna P Sharma, CDC, Atlanta; Amy DeGroff, CDC, Atlanta; Sarah D Hohl, University of Washington; Annette E Maxwell, University of California Los Angeles; Ngoc-Cam Escoffery, Emory University; Susan A Sabatino, CDC, Atlanta; Djenaba A Joseph, CDC, Atlanta
• Language: English
• Date: 2022-07-16
• Publisher: ELSEVIER
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.pmedr.2022.101904
• Title of Journal or Parent Work: PREVENTIVE MEDICINE REPORTS
• Volume: 29
• Start Page: 101904
• End Page: 101904
• Grant/Funding Information: This work was supported, in part, by CDC funds through a contract from the National Association of Chronic Disease Directors to the University of Washington. Additional support was provided by CDC and the National Cancer Institute through the Cancer Prevention and Control Research Network, a network within CDC’s Prevention Research Centers program (Emory University, U48DP006377; University of Washington, U48DP005013 and U48DP006398).
• Keywords: Multicomponent interventions; Science & Technology; Colorectal cancer screening; Public, Environmental & Occupational Health; Evidence-based interventions; Life Sciences & Biomedicine; Primary care clinics; DISPARITIES; Preventive Health
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Implementation of evidence-based interventions (EBIs) increases CRC screening. The purpose of this analysis is to determine which combinations of EBIs or strategies led to increases in clinic-level screening rates among clinics participating in CDC's Colorectal Cancer Control Program (CRCCP). Data were collected from CRCCP clinics between 2015 and 2018 and the analysis was conducted in 2020. The outcome variable was the annual change in clinic level CRC screening rate in percentage points. We used first difference (FD) estimator of linear panel data regression model to estimate the associations of outcome with independent variables, which include different combinations of EBIs and intervention strategies. The study sample included 486 unique clinics with 1156 clinic years of total observations. The average baseline screening rate was 41 % with average annual increase of 4.6 percentage points. Only two out of six combinations of any two EBIs were associated with increases in screening rate (largest was 6.5 percentage points, P < 0.001). Any combinations involving three EBIs or all four EBIs were significantly associated with the outcome with largest increase of 7.2 percentage points (P < 0.001). All interventions involving 2–3 strategies led to increases in rate with largest increase associated with the combination of increasing community demand and access (6.1 percentage points, P < 0.001). Clinics implementing combinations of these EBIs, particularly those including three or more EBIs, often were more likely to have impact on screening rate change than those implementing none.