Organizational Predictors of Colon Cancer Screening

结肠癌筛查的组织预测因素

• 批准号: 6802918
• 负责人: Lynn M Soban
• 金额: $ 3万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-06-01 至 2004-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6802918
• 关键词: colorectal neoplasms; health care quality; health care service organization; health care service utilization; health services research tag; human data; managed care; mathematical model; neoplasm /cancer diagnosis; statistics /biometry

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.

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”，呼吁人们关注对提高美国医疗保健质量至关重要的系统或组织层面因素。此外，了解组织所处的背景或环境对于制定政策相关研究也很重要。过去二十年管理式医疗组织的主导地位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。迄今为止，大多数关于 CRC 筛查的研究都集中在患者个体因素上，而对组织因素的影响知​​之甚少。这项横断面研究使用了多个不同来源的数据，包括：Interstudy、地区资源文件和退伍军人健康管理局 (VHA)。普通最小二乘法和多级逻辑回归模型将用于探讨：(1) 管理式医疗渗透率与 VHA 中管理式医疗实践采用之间的关系，可能影响 CRC 筛查率； (2) VHA 系统内管理式医疗渗透率与接受结直肠癌筛查之间的关系； (3) 管理式医疗渗透率对接受 CRC 筛查的人在 VHA 系统内接受 CRC 筛查的概率的影响。了解 CRC 筛查实施中组织影响和变化之间的关系将有助于更好地了解使用该服务的障碍。此类信息可作为设计干预措施以改善结直肠癌筛查的基础。