Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Cancer. 2021 Apr 1;127(7):1049-1056. doi: 10.1002/cncr.33325. Epub 2020 Dec 10.
The Centers for Disease Control and Prevention (CDC) funds the Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer (CRC) screening rates in primary care clinics by implementing evidence-based interventions (EBIs). This study examined differences in clinic characteristics and implementation efforts among clinics with differential changes in screening rates over time.
CRCCP clinic data collected by the CDC were used. The outcome was the clinic status (highest quartile [Q4] vs lowest quartile [Q1]), which was based on the absolute screening rate change between the first and second program years. Five clinic characteristic variables and 12 clinic-level CRCCP variables (eg, EBIs) were assessed in bivariable analyses, and logistic regression was used to determine significant predictors of the outcome.
Each group included 78 clinics (N = 156). Clinics with a Q4 status saw a 14.9 percentage point increase in the screening rate, whereas clinics with a Q1 status experienced a 9.1 percentage point decline. Q4s were more likely than Q1s to have a CRC champion, implement 4 EBIs versus fewer EBIs, implement at least 1 new EBI, and increase the number of implemented EBIs. The adjusted odds of Q4 status were 5.3 times greater (95% confidence interval [CI], 1.9-14.9) if a clinic implemented an additional EBI. The adjusted odds of Q4 status increased to 7.1 (95% CI, 2.2-23.1) if a clinic implemented 2 to 4 additional EBIs.
Implementing new EBIs or enhancing existing ones improves CRC screening rates. Additionally, clinics with lower screening rates had greater rate increases and may have benefited more from the CRCCP.
疾病控制与预防中心 (CDC) 通过实施基于证据的干预措施 (EBIs) 为结直肠癌控制计划 (CRCCP) 提供资金，以提高初级保健诊所的结直肠癌 (CRC) 筛查率。本研究考察了随着时间的推移筛查率发生差异变化的诊所的临床特征和实施工作方面的差异。
使用由疾病预防控制中心收集的 CRCCP 诊所数据。结果是诊所的状态（最高四分位数 [Q4] 与最低四分位数 [Q1]），这是基于第一个和第二个项目年度之间的绝对筛查率变化。在双变量分析中评估了 5 个临床特征变量和 12 个诊所级 CRCCP 变量（例如，EBI），并使用逻辑回归确定结果的显著预测因素。
每个组包括 78 个诊所（N=156）。Q4 组的筛查率增加了 14.9 个百分点，而 Q1 组的筛查率下降了 9.1 个百分点。与 Q1 组相比，Q4 组更有可能有 CRC 冠军，实施 4 项 EBI 而不是更少的 EBI，实施至少 1 项新的 EBI，并增加实施的 EBI 数量。如果一个诊所实施了额外的 EBI，则 Q4 状态的调整后优势比为 5.3 倍（95%置信区间 [CI]，1.9-14.9）。如果诊所实施了 2 到 4 项额外的 EBI，则 Q4 状态的调整后优势比增加到 7.1（95% CI，2.2-23.1）。
实施新的 EBI 或增强现有的 EBI 可以提高 CRC 筛查率。此外，筛查率较低的诊所增加幅度更大，可能从 CRCCP 中受益更多。
