Primary Care Practice Organization Influences Colorectal Cancer Screening Performance

Colorectal cancer (CRC), a major source of preventable cancer morbidity and mortality, accounts for 10 percent of all U.S. cancer deaths. Despite the availability of effective screening tests and the necessity of early detection, nationwide screening rates for CRC remain low. This study collected CRC screening data from 155 VA primary care practices and assessed the practice characteristics associated with a stronger CRC screening performance. The researchers reviewed chart-based evidence for 38,818 eligible patients. Practices were characterized by degree of centralization, resources and complexity, i.e., facility size, academic status and managed care penetration. Of the clinics involved, 97 were hospital-based and 58 were community-based practices.

The researchers found that patients who receive care in clinics with higher levels of local practice autonomy and with greater support resources (adequately equipped exam rooms and sufficient computer access), are more likely to receive CRC screening. In addition, practices that are smaller in size have a higher screening performance. This VA case example shows that improving quality of care in U.S. health settings may be achieved when provider, organizational and public policy barriers are addressed.