Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multilevel Analysis

Wang, Hongmei; Qiu, Fang; Gregg, Abbey; Chen, Baojiang; Kim, Jungyoon; Young, Lufei; Wan, Neng; Chen, Li Wu

doi:10.1111/jrh.12248

Cited by 15 publications

(13 citation statements)

References 50 publications

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“…Within our population, PCP visits and the presence of chronic conditions were the biggest determinants of CRC screening within 12 months. Individuals who visit their PCP or who have a chronic condition may be more actively engaged in their health and more likely to get screened than those who have not seen their PCP in the calendar year or who do not have a chronic condition [6, 25, 26]. Given efforts to promote CRC screening through policy in Oregon, providers may have been more likely to recommend screening during the study window.…”

Section: Discussionmentioning

confidence: 99%

Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies

OʼLeary

Lich

et al. 2019

BMC Health Serv Res

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Background Colorectal cancer (CRC) screening is underutilized by Medicaid enrollees and the uninsured. Multiple national and state policies were enacted from 2010 to 2014 to increase access to Medicaid and to promote CRC screening among Medicaid enrollees. We aimed to determine the impact of these policies on screening initiation among newly enrolled Oregon Medicaid beneficiaries age-eligible for CRC screening. Methods We identified national and state policies affecting Medicaid coverage and preventive services in Oregon during 2010–2014. We used Oregon Medicaid claims data from 2010 to 2015 to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening (a prevention milestone, and an age at which guideline-concordant screening can be assessed within a single year) during each year from 2010 to 2014. We calculated risk ratios to assess whether first year of Medicaid enrollment and/or year turned 50 was associated with CRC screening initiation. Results We identified 14,576 Oregon Medicaid enrollees who turned 50 during 2010–2014; 2429 (17%) completed CRC screening within 12 months after turning 50. Individuals newly enrolled in Medicaid in 2013 or 2014 were 1.58 and 1.31 times more likely, respectively, to initiate CRC screening than those enrolled by 2010. A primary care visit in the calendar year, having one or more chronic conditions, and being Hispanic was also associated with CRC screening initiation . Discussion The increased uptake of CRC screening in 2013 and 2014 is associated with the timing of policies such as Medicaid expansion, enhanced federal matching for preventive services offered to Medicaid enrollees without cost sharing, and formation of Medicaid accountable care organizations, which included CRC screening as an incentivized quality metric. Electronic supplementary material The online version of this article (10.1186/s12913-019-4113-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies

OʼLeary

Lich

et al. 2019

BMC Health Serv Res

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“…A possible explanation for the findings might be socioeconomic differences in health behaviours, such as cancer screening, and cancer risk factors. Some studies found that individuals from low socioeconomic status may have barriers that impact participation in screening and thus detection (Deding et al 2017 ; Wang et al 2017 ). This situation may lead to higher cancer rates for individuals from high than low socioeconomic status that are actually caused by increased detection and not true differences.…”

Section: Discussionmentioning

confidence: 99%

Effect of childhood socioeconomic conditions on cancer onset in later life: an ambidirectional cohort study

Linden

Courvoisier

Cheval

et al. 2018

Int J Public Health

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ObjectivesLiving in low socioeconomic conditions during childhood is associated with poor health outcomes in later life. Whether this link also applies to cancer is unclear. We examined whether childhood socioeconomic conditions (CSCs) are associated with cancer risk in later life and whether this effect remained after adjusting for adulthood socioeconomic conditions (ASCs).MethodsData for 26,431 individuals ≥ 50 years old included in SHARE were analysed. CSCs were constructed by using indicators of living conditions at age 10. ASC indicators were education, main occupation, and household income. Gender-stratified associations of CSCs with cancer onset (overall and by site) were assessed by Cox regression.ResultsIn total, 2852 individuals were diagnosed with cancer. For both men and women, risk of overall cancer was increased for advantaged CSCs and remained so after adjusting for ASCs (hazard ratio = 1.36, 95% CI 1.10, 1.63, and 1.70, 95% CI 1.41, 2.07).ConclusionsAdvantaged CSCs are associated with an increased risk of overall cancer at older age, but results vary by cancer sites and sex. Participation in cancer screening or exposure to risk factors may differ by social conditions.Electronic supplementary materialThe online version of this article (10.1007/s00038-018-1111-9) contains supplementary material, which is available to authorized users.

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“…Since ACOs are paid a set amount for each patient enrolled, ACO implementation is anticipated to lead to improved coordination, wiser spending, and improved quality of care by delivering the right care to the right patient at the right time. One quality indicator across many ACO initiatives is CRC screening [26, 27]. However, the interventions that ACOs pursue and how they implement them may vary drastically and have implications on program effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?

Davis

Shafer

Renfro

et al. 2019

BMC Health Serv Res

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BackgroundHealth care reform is changing preventive services delivery. This study explored trajectories in colorectal cancer (CRC) testing over a 5-year period that included implementation of 16 Medicaid Accountable Care Organizations (ACOs, 2012) and Medicaid expansion (2014) – two provisions of the Affordable Care Act (ACA) - within the state of Oregon, USA.MethodsRetrospective analysis of Oregon’s Medicaid claims for enrollee’s eligible for CRC screening (50–64 years) spanning January 2010 through December 2014. Our analysis was conducted and refined April 2016 through June 2018. The analysis assessed the annual probability of patients receiving CRC testing and the modality used (e.g., colonoscopy, fecal testing) relative to a baseline year (2010). We hypothesized that CRC testing would increase following Medicaid ACO formation – called Coordinated Care Organizations (CCOs).ResultsA total of 132,424 unique Medicaid enrollees (representing 255,192 person-years) met inclusion criteria over the 5-year study. Controlling for demographic and regional factors, the predicted probability of CRC testing was significantly higher in 2014 (+ 1.4 percentage points, p < 0.001) compared to the 2010 baseline but not in 2012 or 2013. Increased fecal testing using Fecal Occult Blood Tests (FOBT) or Fecal Immunochemical Tests (FIT) played a prominent role in 2014. The uptick in statewide fecal testing appears driven primarily by a subset of CCOs.ConclusionsObserved CRC testing did not immediately increase following the transition to CCOs in 2012. However increased testing in 2014, may reflect a delay in implementation of interventions to increase CRC screening and/or a strong desire by newly insured Medicaid CCO members to receive preventive care.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3864-5) contains supplementary material, which is available to authorized users.

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Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multilevel Analysis

Cited by 15 publications

References 50 publications

Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies

Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies

Effect of childhood socioeconomic conditions on cancer onset in later life: an ambidirectional cohort study

Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?

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