title: Primary care practice organization influences colorectal cancer screening performance.
abstract: OBJECTIVE
  To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors.
  
  
  METHODS
  Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001).
  
  
  METHODS
  Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors.
  
  
  METHODS
  Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease.
  
  
  RESULTS
  After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001).
  
  
  CONCLUSIONS
  Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.
authors.affiliation: VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda VA Ambulatory Care Center, Sepulveda, CA 91343, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Soban
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Parkerton
authors.forename: David A
authors.initials: DA
authors.lastname: Etzioni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002140:California; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000145:classification / Q000706:statistics & numerical data*; D008875:Middle Aged; D016134:Organizational Policy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D017009:Professional Autonomy; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014728:Veterans / Q000706:statistics & numerical data*