Organizational Factors Affecting the Likelihood of Cancer Screening Among VA Patients. Issue 12 (December 2015)

• Record Type: Journal Article
• Authors: Chou, Ann F.; Rose, Danielle E.; Farmer, Melissa; Canelo, Ismelda; Yano, Elizabeth M.
• Is Part Of: Medical care. Volume 53:Issue 12(2015)
• Publication Date: 2015-12
• Subjects: preventive care -- quality improvement -- implementation -- cancer screening -- health organizations; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000449
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Preventive service delivery, including cancer screenings, continues to pose a challenge to quality improvement efforts. Although many studies have focused on person-level characteristics associated with screening, less is known about organizational influences on cancer screening. Objectives: This study aims to understand the association between organizational factors and adherence to cancer screenings. Methods: This study employed a cross-sectional design using organizational-level, patient-level, and area-level data. Dependent variables included breast, cervical, and colorectal cancer screening. Organizational factors describing resource sufficiency were constructed using factor analyses from a survey of 250 Veterans Affairs primary care directors. We conducted random-effects logistic regression analyses, modeling cancer screening as a function of organizational factors, controlling for patient-level and area-level factors. Results: Overall, 87% of the patients received mammograms, 92% received cervical and 78% had colorectal screening. Quality improvement orientation increased the odds of cervical [odds ratio (OR): 1.27; 95% confidence interval (CI), 1.03–1.57] and colorectal cancer screening (OR: 1.10; 95% CI, 1.00–1.20). Authority in determining primary care components increased the odds of mammography screening (OR: 1.23; 95% CI, 1.03–1.51). Sufficiency in clinical staffing increased the odds of mammography and cervical cancer screenings. Several patient-level factors, serving as control variables, were associated with achievement of screenings. Conclusions: Resource sufficiency led to increased odds of screening possibly because they promote excellence in patient care by conveying organizational goals and facilitate goal achievement with resources. Complementary to patient-level factors, our findings identified organizational processes associated with better performance, which offer concrete strategies in which facilities can evaluate their capabilities to implement best practices to foster and sustain a culture of quality care. Abstract : Supplemental Digital Content is available in the text.