Physicians, clinics, and neighborhoods

Multiple levels of influence on colorectal cancer screening

Sandi L. Pruitt, Tammy Leonard, Song Zhang, Mario Schootman, Ethan A. Halm, Samir Gupta

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background:We(i) described variability in colorectal cancer (CRC) test use across multiple levels, including physician, clinic, and neighborhood; and (ii) compared the performance of novel cross-classified models versus traditional hierarchical models. Methods:Weexamined multilevel variation inCRCtest use among patients not up-to-date with screening in a large, urban safety net health system (2011-2012). Outcomes included: (i) fecal occult blood test (FOBT) or (ii) colonoscopy and were ascertained using claims data during a 1-year follow-up. We compared Bayesian (i) cross-classified four-level logistic models nesting patients within separate, nonoverlapping -levels- (physicians, clinics, and census tracts) versus (ii) three hierarchical two-level models using deviance information criterion. Models were adjusted for covariates (patient sociodemographic factors, driving time to clinic, and census tract poverty rate). Results: Of 3,195 patients, 157 (4.9%) completed FOBT and 292 (9.1%) completed colonoscopy during the study year. Patients attended 19 clinics, saw 177 physicians, and resided in 332 census tracts. Significant variability was observed across all levels in both hierarchical and cross-classified models that was unexplained by measured covariates. For colonoscopy, variance was similar across all levels. For FOBT, physicians, followed by clinics, demonstrated the largest variability. Model fit using cross-classified models was superior or similar to 2-level hierarchical models. Conclusions: Significant and substantial variability was observed across neighborhood, physician, and clinic levels in CRC test use, suggesting the importance of factors at each of these levels on CRC testing. Impact: Future multilevel research and intervention should consider the simultaneous influences of multiple levels, including clinic, physician, and neighborhood.

Original languageEnglish (US)
Pages (from-to)1346-1355
Number of pages10
JournalCancer Epidemiology Biomarkers and Prevention
Volume23
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Early Detection of Cancer
Colorectal Neoplasms
Physicians
Occult Blood
Hematologic Tests
Censuses
Colonoscopy
Poverty
Logistic Models
Safety
Health
Research

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Physicians, clinics, and neighborhoods : Multiple levels of influence on colorectal cancer screening. / Pruitt, Sandi L.; Leonard, Tammy; Zhang, Song; Schootman, Mario; Halm, Ethan A.; Gupta, Samir.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 23, No. 7, 2014, p. 1346-1355.

Research output: Contribution to journalArticle

@article{16f30ff9214848ee93c27546036d401f,
title = "Physicians, clinics, and neighborhoods: Multiple levels of influence on colorectal cancer screening",
abstract = "Background:We(i) described variability in colorectal cancer (CRC) test use across multiple levels, including physician, clinic, and neighborhood; and (ii) compared the performance of novel cross-classified models versus traditional hierarchical models. Methods:Weexamined multilevel variation inCRCtest use among patients not up-to-date with screening in a large, urban safety net health system (2011-2012). Outcomes included: (i) fecal occult blood test (FOBT) or (ii) colonoscopy and were ascertained using claims data during a 1-year follow-up. We compared Bayesian (i) cross-classified four-level logistic models nesting patients within separate, nonoverlapping -levels- (physicians, clinics, and census tracts) versus (ii) three hierarchical two-level models using deviance information criterion. Models were adjusted for covariates (patient sociodemographic factors, driving time to clinic, and census tract poverty rate). Results: Of 3,195 patients, 157 (4.9{\%}) completed FOBT and 292 (9.1{\%}) completed colonoscopy during the study year. Patients attended 19 clinics, saw 177 physicians, and resided in 332 census tracts. Significant variability was observed across all levels in both hierarchical and cross-classified models that was unexplained by measured covariates. For colonoscopy, variance was similar across all levels. For FOBT, physicians, followed by clinics, demonstrated the largest variability. Model fit using cross-classified models was superior or similar to 2-level hierarchical models. Conclusions: Significant and substantial variability was observed across neighborhood, physician, and clinic levels in CRC test use, suggesting the importance of factors at each of these levels on CRC testing. Impact: Future multilevel research and intervention should consider the simultaneous influences of multiple levels, including clinic, physician, and neighborhood.",
author = "Pruitt, {Sandi L.} and Tammy Leonard and Song Zhang and Mario Schootman and Halm, {Ethan A.} and Samir Gupta",
year = "2014",
doi = "10.1158/1055-9965.EPI-13-1130",
language = "English (US)",
volume = "23",
pages = "1346--1355",
journal = "Cancer Epidemiology Biomarkers and Prevention",
issn = "1055-9965",
publisher = "American Association for Cancer Research Inc.",
number = "7",

}

TY - JOUR

T1 - Physicians, clinics, and neighborhoods

T2 - Multiple levels of influence on colorectal cancer screening

AU - Pruitt, Sandi L.

AU - Leonard, Tammy

AU - Zhang, Song

AU - Schootman, Mario

AU - Halm, Ethan A.

AU - Gupta, Samir

PY - 2014

Y1 - 2014

N2 - Background:We(i) described variability in colorectal cancer (CRC) test use across multiple levels, including physician, clinic, and neighborhood; and (ii) compared the performance of novel cross-classified models versus traditional hierarchical models. Methods:Weexamined multilevel variation inCRCtest use among patients not up-to-date with screening in a large, urban safety net health system (2011-2012). Outcomes included: (i) fecal occult blood test (FOBT) or (ii) colonoscopy and were ascertained using claims data during a 1-year follow-up. We compared Bayesian (i) cross-classified four-level logistic models nesting patients within separate, nonoverlapping -levels- (physicians, clinics, and census tracts) versus (ii) three hierarchical two-level models using deviance information criterion. Models were adjusted for covariates (patient sociodemographic factors, driving time to clinic, and census tract poverty rate). Results: Of 3,195 patients, 157 (4.9%) completed FOBT and 292 (9.1%) completed colonoscopy during the study year. Patients attended 19 clinics, saw 177 physicians, and resided in 332 census tracts. Significant variability was observed across all levels in both hierarchical and cross-classified models that was unexplained by measured covariates. For colonoscopy, variance was similar across all levels. For FOBT, physicians, followed by clinics, demonstrated the largest variability. Model fit using cross-classified models was superior or similar to 2-level hierarchical models. Conclusions: Significant and substantial variability was observed across neighborhood, physician, and clinic levels in CRC test use, suggesting the importance of factors at each of these levels on CRC testing. Impact: Future multilevel research and intervention should consider the simultaneous influences of multiple levels, including clinic, physician, and neighborhood.

AB - Background:We(i) described variability in colorectal cancer (CRC) test use across multiple levels, including physician, clinic, and neighborhood; and (ii) compared the performance of novel cross-classified models versus traditional hierarchical models. Methods:Weexamined multilevel variation inCRCtest use among patients not up-to-date with screening in a large, urban safety net health system (2011-2012). Outcomes included: (i) fecal occult blood test (FOBT) or (ii) colonoscopy and were ascertained using claims data during a 1-year follow-up. We compared Bayesian (i) cross-classified four-level logistic models nesting patients within separate, nonoverlapping -levels- (physicians, clinics, and census tracts) versus (ii) three hierarchical two-level models using deviance information criterion. Models were adjusted for covariates (patient sociodemographic factors, driving time to clinic, and census tract poverty rate). Results: Of 3,195 patients, 157 (4.9%) completed FOBT and 292 (9.1%) completed colonoscopy during the study year. Patients attended 19 clinics, saw 177 physicians, and resided in 332 census tracts. Significant variability was observed across all levels in both hierarchical and cross-classified models that was unexplained by measured covariates. For colonoscopy, variance was similar across all levels. For FOBT, physicians, followed by clinics, demonstrated the largest variability. Model fit using cross-classified models was superior or similar to 2-level hierarchical models. Conclusions: Significant and substantial variability was observed across neighborhood, physician, and clinic levels in CRC test use, suggesting the importance of factors at each of these levels on CRC testing. Impact: Future multilevel research and intervention should consider the simultaneous influences of multiple levels, including clinic, physician, and neighborhood.

UR - http://www.scopus.com/inward/record.url?scp=84903996444&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903996444&partnerID=8YFLogxK

U2 - 10.1158/1055-9965.EPI-13-1130

DO - 10.1158/1055-9965.EPI-13-1130

M3 - Article

VL - 23

SP - 1346

EP - 1355

JO - Cancer Epidemiology Biomarkers and Prevention

JF - Cancer Epidemiology Biomarkers and Prevention

SN - 1055-9965

IS - 7

ER -