Organizational Predictors of Colon Cancer Screening

描述(由申请人提供)：最近的几份报告，包括医学研究所的“跨越质量鸿沟”，呼吁注意系统或组织层面的因素，认为这是提高美国医疗保健质量的关键。此外，了解组织存在的背景或环境对于制定与政策相关的研究也很重要。管理型医疗组织在过去20年中的主导地位，就是环境影响改变了美国医疗保健的组织和提供的一个例子。拟议研究的目的是检查组织的环境背景如何影响组织结构和流程，并最终影响现场提供的护理。本研究的临床重点是结直肠癌(CRC)筛查。到目前为止，关于结直肠癌筛查的研究大多集中在个体患者水平的因素上，对组织因素的影响知之甚少。这项横断面研究使用了来自几个不同来源的数据，包括：InterStudy、区域资源文件和退伍军人健康管理局(VHA)。我们将使用普通最小二乘和多水平Logistic回归模型来探讨：(1)管理式医疗渗透率与VHA采用管理式医疗做法之间的关系，这可能会影响结直肠癌筛查率；(2)管理式医疗渗透率与VHA系统内接受结直肠癌筛查的关系；(3)管理式医疗渗透率对接受结直肠癌筛查的VHA系统内接受CRC筛查的概率的影响。了解组织影响和提供CRC筛查的差异之间的关系将有助于更好地了解使用这项服务的障碍。这些信息可作为设计干预措施的基础，以改进对儿童的筛查。

DESCRIPTION (provided by the applicant): Several recent reports including the Institute of Medicine's "Crossing the Quality Chasm" have called attention to systems or organizational level factors as critical to the improvement of health care quality in the United States. In addition, understanding the context or environment in which an organization exists is also important to crafting policy-relevant research. The predominance of managed care organizations over the last two decades is an example of an environmental influence that has changed the organization and delivery of health care in the United States. The purpose of the proposed research is to examine how the environmental context of an organization influences organizational structures and processes and ultimately affects the care delivered at the site. The clinical focus of this study is colorectal cancer (CRC) screening. To date, most of the research on the delivery of CRC screening has focused on individual patient-level factors, leaving the influence of organizational factors poorly understood. This cross sectional study uses data from several different sources including: Interstudy, the Area Resource File, and the Veteran's Health Administration (VHA). Ordinary least squares and multi-level logistic regression models will be used to explore: (1) the relationship between managed care penetration and adoption of managed care practices in the VHA that may affect CRC screening rates; (2) the relationship between managed care penetration and receipt of colorectal cancer screening within the VHA system; and (3) the effect of managed care penetration on the probability of receiving CRC screening inside the VHA system among those who received CRC screening. Understanding the relationship of organizational influences and variations in the delivery of CRC screening will provide a better understanding of the barriers to the use of this service. Such information may serve as the basis for the design of interventions to improve CRC screening.