Screening for Colorectal Cancer: An Integrated Approach

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Colorectal cancer screening procedures are highly underused. We propose an integrated, interdisciplinary, and multi-level approach to understanding and increasing the use of colorectal cancer screening. We will conduct a study with a series of integrated aims to examine who gets screening and what tests they get, why people don't get screening, and what the most cost-effective methods of screening are. The results will be useful in developing new approaches, interventions, and policies to increase screening and in developing new screening methods. Specific aims are to: (1) Examine the Individual and Area-Level Predictors of Colorectal Cancer Screening Utilization We will use nationally representative data from the National Health Interview Survey and Medical Expenditure Panel Survey that we will link to provider/plan and area-level data. We will focus particularly on the impact of (a) specific health plan characteristics and (b) area-level characteristics. (2) Analyze Patient Preferences for Colorectal Cancer Screening Methods We will use a quantitative and economic-theory based approach as well as a qualitative approach to measuring preferences. We will focus particularly on (a) how much patients value the various attributes of current and new screening tests; (b) how utilization of screening methods is associated with preferences for those methods; and (c) how differences across and within health care insurance systems influence perceptions of screening methods, cost, and willingness-to-pay. (3) Conduct Cost-Effectiveness and Cost-Benefit Analyses of Colorectal Cancer Screening We will adapt a previously developed, validated cancer screening model to examine the cost-effectiveness and net benefits of colorectal cancer screening methods. We will focus particularly on the influence of (a) utilization rates (Aim #1) and (b) patient preferences for current and new screening methods (Aim #2).