Sharma Krishna P, DeGroff Amy, Hohl Sarah D, Maxwell Annette E, Escoffery Ngoc Cam, Sabatino Susan A, Joseph Djenaba A
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States.
Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, United States.
Prev Med Rep. 2022 Jul 9;29:101904. doi: 10.1016/j.pmedr.2022.101904. eCollection 2022 Oct.
Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Implementation of evidence-based interventions (EBIs) increases CRC screening. The purpose of this analysis is to determine which combinations of EBIs or strategies led to increases in clinic-level screening rates among clinics participating in CDC's Colorectal Cancer Control Program (CRCCP). Data were collected from CRCCP clinics between 2015 and 2018 and the analysis was conducted in 2020. The outcome variable was the annual change in clinic level CRC screening rate in percentage points. We used first difference (FD) estimator of linear panel data regression model to estimate the associations of outcome with independent variables, which include different combinations of EBIs and intervention strategies. The study sample included 486 unique clinics with 1156 clinic years of total observations. The average baseline screening rate was 41 % with average annual increase of 4.6 percentage points. Only two out of six combinations of any two EBIs were associated with increases in screening rate (largest was 6.5 percentage points, P < 0.001). Any combinations involving three EBIs or all four EBIs were significantly associated with the outcome with largest increase of 7.2 percentage points (P < 0.001). All interventions involving 2-3 strategies led to increases in rate with largest increase associated with the combination of increasing community demand and access (6.1 percentage points, P < 0.001). Clinics implementing combinations of these EBIs, particularly those including three or more EBIs, often were more likely to have impact on screening rate change than those implementing none.
结直肠癌（CRC）筛查已被证明可降低结直肠癌死亡率。实施循证干预措施（EBIs）可提高CRC筛查率。本分析的目的是确定哪些EBIs组合或策略能使参与美国疾病控制与预防中心（CDC）结直肠癌控制项目（CRCCP）的诊所的临床筛查率提高。2015年至2018年期间从CRCCP诊所收集数据，并于2020年进行分析。结果变量是临床层面CRC筛查率的年度变化，以百分点计。我们使用线性面板数据回归模型的一阶差分（FD）估计器来估计结果与自变量之间的关联，自变量包括EBIs和干预策略的不同组合。研究样本包括486家独特的诊所，共有1156个诊所年的观察数据。平均基线筛查率为41%，平均每年增加4.6个百分点。任意两种EBIs的六种组合中只有两种与筛查率增加相关（最大增加6.5个百分点，P<0.001）。涉及三种EBIs或所有四种EBIs的任意组合均与结果显著相关，最大增加7.2个百分点（P<0.001）。所有涉及2 - 3种策略的干预措施均导致筛查率增加，与增加社区需求和可及性的组合相关的增加幅度最大（6.1个百分点，P<0.001）。实施这些EBIs组合的诊所，尤其是那些包括三种或更多EBIs的诊所，往往比未实施的诊所更有可能对筛查率变化产生影响。
