Multi-level Influences on Breast Cancer Screening in Primary Care
Multi-level Influences on Breast Cancer Screening in Primary Care
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DOI：
10.1007/s11606-018-4560-1
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发表时间：
2018-10-01
影响因子：
5.7
通讯作者：
Tosteson, Anna N. A.
中科院分区：
文献类型：
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作者：
Onega, Tracy;Tosteson, Tor D.;Tosteson, Anna N. A.
乳腺癌筛查的使用受患者、初级保健提供者、实践和卫生系统相关因素的影响。我们检查了这些嵌套水平对四种乳腺癌筛查指标的相对影响。在两个卫生系统内的15个初级保健实践中完成了一项基于网络的调查，代表了306个初级保健提供者（PCP），944名妇女在2011年1月至2014年9月期间接受了初级保健。分析发生在2017年1月至2017年5月之间。在四个嵌套水平（患者，PCP，初级保健实践和卫生系统）中，报告了初级保健实践特征的频率分布和调整率以及四个乳腺筛查指标的调查结果（总体筛查百分比，以及40-49岁，50-74岁和75岁以上的筛查百分比）。我们使用分层多水平混合和随机效应分析来评估PCP、初级保健实践和卫生系统对乳腺癌筛查指标的相对影响。总体而言，接受乳腺癌筛查的女性比例为73.1%（40-49岁为73.4%，50-74岁为76.5%，75岁以上为51.1%）。患者种族和初级保健就诊次数与筛查率密切相关。在调整妇女水平的因素，24%的整体变化之间的PCP可归因于初级保健实践水平，35%的卫生系统水平，和41%的实践中的PCP之间的剩余变化。没有具体的供应商层面的特征被发现是统计上显着的决定因素的筛查率。在占妇女层面的特征，其余的变化，在乳腺癌筛查主要是由于供应商和卫生系统的变化。
Use of breast cancer screening is influenced by factors associated with patients, primary care providers, practices, and health systems.We examined the relative effects of these nested levels on four breast cancer screening metrics.A web-based survey was completed at 15 primary care practices within two health systems representing 306 primary care providers (PCPs) serving 46,944 women with a primary care visit between 1/2011-9/2014. Analyses occurred between 1/2017 and 5/2017.Across four nested levels (patient, PCP, primary care practice, and health system), frequency distributions and adjusted rates of primary care practice characteristics and survey results for four breast screening metrics (percent screened overall, and percent screened age 40-49, 50-74, and 75+) were reported. We used hierarchical multi-level mixed and random effects analysis to assess the relative influences of PCP, primary care practice, and health system on the breast screening metrics.Overall, the proportion of women undergoing breast cancer screening was 73.1% (73.4% for ages 40-49, 76.5% for 50-74, and 51.1% for 75+). Patient ethnicity and number of primary care visits were strongly associated with screening rates. After adjusting for woman-level factors, 24% of the overall variation among PCPs was attributable to the primary care practice level, 35% to the health system level, and 41% to the residual variation among PCPs within practice. No specific provider-level characteristics were found to be statistically significant determinants of screening rates.After accounting for woman-level characteristics, the remaining variation in breast cancer screening was largely due to provider and health system variation.