Race/ethnicity and adoption of a population health management approach to colorectal cancer screening in a community-based healthcare system Journal Article


Authors: Mehta, S. J.; Jensen, C. D.; Quinn, V. P.; Schottinger, J. E.; Zauber, A. G.; Meester, R.; Laiyemo, A. O.; Fedewa, S.; Goodman, M.; Fletcher, R. H.; Levin, T. R.; Corley, D. A.; Doubeni, C. A.
Article Title: Race/ethnicity and adoption of a population health management approach to colorectal cancer screening in a community-based healthcare system
Abstract: Background: Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. Objective: To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program. Design: Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004–2013). Subjects: A total of 868,934 screen-eligible individuals 51–74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004–2006), 654,633 during the first 3 years after implementation (2007–2009), and 665,268 in the period from 4 to 7 years (2010–2013) after program implementation. Intervention: A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits. Main Measures: Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races. Key Results: From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02–1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96–0.97). There were also substantial improvements in timely follow-up of positive screening results. Conclusions: In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT. © 2016, Society of General Internal Medicine.
Keywords: colorectal cancer; cancer screening; health care delivery; population health; race & ethnicity
Journal Title: Journal of General Internal Medicine
Volume: 31
Issue: 11
ISSN: 0884-8734
Publisher: Springer  
Date Published: 2016-11-01
Start Page: 1323
End Page: 1330
Language: English
DOI: 10.1007/s11606-016-3792-1
PROVIDER: scopus
PMCID: PMC5071288
PUBMED: 27412426
DOI/URL:
Notes: Article -- Export Date: 1 November 2016 -- Source: Scopus
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  1. Ann G Zauber
    314 Zauber