Davis Melinda M, Shafer Paul, Renfro Stephanie, Hassmiller Lich Kristen, Shannon Jackilen, Coronado Gloria D, McConnell K John, Wheeler Stephanie B
Department of Family Medicine, OHSU-PSU School of Public Health, and Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L222, Portland, OR, 97239, USA.
Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
BMC Health Serv Res. 2019 Jan 21;19(1):54. doi: 10.1186/s12913-018-3864-5.
Health 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.
Retrospective 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).
A 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.
Observed 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.
医疗保健改革正在改变预防服务的提供方式。本研究探讨了美国俄勒冈州在5年期间结直肠癌（CRC）检测的轨迹，这5年包括16个医疗补助责任医疗组织（ACO，2012年）的实施以及医疗补助扩大（2014年）——《平价医疗法案》（ACA）的两项条款。
对2010年1月至2014年12月期间俄勒冈州符合CRC筛查条件（50 - 64岁）的医疗补助参保者的医疗补助申请进行回顾性分析。我们的分析于2016年4月至2018年6月进行并完善。该分析评估了患者接受CRC检测的年度概率以及相对于基线年份（2010年）所使用的检测方式（如结肠镜检查、粪便检测）。我们假设在医疗补助ACO形成后（称为协调护理组织，CCO），CRC检测将会增加。
在为期5年的研究中，共有132,424名独特的医疗补助参保者（代表255,192人年）符合纳入标准。在控制人口统计学和区域因素后，与2010年基线相比，2014年CRC检测的预测概率显著更高（增加1.4个百分点，p < 0.001），但在2012年或2013年并非如此。2014年，使用粪便潜血试验（FOBT）或粪便免疫化学试验（FIT）进行的粪便检测增加起到了显著作用。全州范围内粪便检测的增加似乎主要由一部分CCO推动。
2012年向CCO过渡后，观察到的CRC检测并没有立即增加。然而，2014年检测的增加可能反映了增加CRC筛查干预措施实施的延迟和/或新参保的医疗补助CCO成员接受预防保健的强烈愿望。
