1. The Effect of Key Organizational Attributes on Cancer Screening Rates
Eric Shaw, Bijal Balasubramanian, Alicja Piasecki, Pamela Ohman-Strickland, Jeanne Ferrante, A John Orzano, Benjamin Crabtree
University of Medicine & Dentistry of New Jersey – Robert Wood Johnson Medical School, Somerset, NJ
Funded by: The National Cancer Institute R01 NCI CA11287 (PI: Crabtree)

2. Background
Most assessments of cancer screening deficiencies have focused on
patient factors (eg., payment sources, knowledge deficits, preferences/attitudes)
physician factors (eg., verbal recommendations for screening, training, beliefs about test performance)
Effect of organizational factors of primary care practices remains understudied

3. Recent advancements in understanding organizational factors:
Interventions that focus on changing organizational care processes have the largest effects on prevention performance
Stone, EG et al. Interventions that Increase Use of Adult Immunization and Cancer Screening Services: A Meta- Analysis. Ann Intern Med 2002; 136:
Smaller practice size, greater autonomy over care delivery, and more clinical support influenced CRC screening
Yano, EM et al. Practice Care Practice Organization Influences Colorectal Cancer Screening Performance. HSR 2007; 42:
Gap in research on community-based primary care practice organizational factors and multiple cancer screening tests

4. Purpose of this Paper
To evaluate the association between key organizational attributes of primary care practices and screening for breast, cervical, colorectal, and prostate cancer

5. Theoretical Lens
Cohen D et al. A Practice Change Model for Quality Improvement in Primary Care Practice. J Health Mgmt 2004; 49:3:

6. Methods
Design: Cross sectional analysis using data from patient surveys, chart audit, and practice surveys from SCOPE
Participants: Consecutive sample of ~30 patients,
aged > 50, from 24 NJ family medicine practices
Outcome Measures:
Mammography (women ≥ 50 yrs, yearly)
Pap smear (women yrs, every 3 years)
Prostate cancer screening (men yrs, yearly)
Colorectal cancer screening (men and women ≥ 50 yrs)
FOBT (1 yr), flex sig (5 yr), colonoscopy (10 yr), or BE (5 yr)

7. Key Organizational Attributes
Factor analysis of practice surveys resulted in 5 stable factors*
Communication
Teamwork
Access to information
Practice busyness/chaos
History of change
* Followed strategy used by: Ohman-Strickland PA, et al. Measuring Organizational Attributes of Primary Care Practices: Development of a New Instrument. HSR; 2007:1-17.

8. Analysis
Hierarchical logistical regression adjusting for patient age, gender, race/ethnicity, comorbidity, presence of EMR
Adjusts for the correlation of patients clustered within practices

9. Demographics
Most practices were single specialty (family medicine) group practices owned by clinicians
Mean patient age was 64 years (SD = 10)
61% female
69% white, 18% black, 9% Hispanic, 4% other
11 of 24 practices had EMRs

10. Results Cancer Screening Teamwork History of Change - mammography
OR = 1.8 p = .04
- CRC screening
OR = 1.9, p = .05
History of Change
OR = 4.2, p = .008

11. Teamwork
Communication
Access to info
History of change

12. Results Resources for Change Cancer Screening - Communication
- History of change
Cancer Screening
- Access to info
Level of chaos

13. Discussion
Teamwork and history of change were important for increased CA screening rates
Unpack dynamic interplay among practices’ “resources for change”
Next steps: test this model using other datasets
While patient and physician factors must not be ignored, interventions aimed at improving cancer screening rates should consider practice-level factors