title: Colorectal Cancer Screening Rates Increased after Exposure to the Patient-Centered Medical Home (PCMH).
abstract: OBJECTIVE
  The patient-centered medical home (PCMH) includes comprehensive chronic illness and preventive services, including identifying patients who are overdue for colorectal cancer screening (CRCS). The association between PCMH implementation and CRCS during the Systems of Support to Increase Colorectal Cancer Screening Trial (SOS) is described.
  
  
  METHODS
  The SOS enrolled 4664 patients from 21 clinics from August 2008 to November 2009. Patients were randomized to usual care, mailed fecal kits, kits plus brief assistance, or kits plus assistance and navigation. A PCMH model that included a workflow for facilitating CRCS was implemented at all study clinics in late 2009. Patients enrolled early had little exposure to the PCMH, whereas patients enrolled later were exposed during most of their first year in the trial. Logistic regression models were used to assess the association between PCMH exposure and CRCS.
  
  
  RESULTS
  Usual care patients with ≥8 months in the PCMH had higher CRCS rates than those with ≤4 months in the PCMH (adjusted difference, 10.1%; 95% confidence interval, 5.7-14.6). SOS interventions led to significant increases in CRCS, but the magnitude of effect was attenuated by exposure to the PCMH (P for interaction = .01).
  
  
  CONCLUSIONS
  Exposure to a PCMH was associated with higher CRCS rates. Automated mailed and centrally delivered stepped interventions increased CRCS rates, even in the presence of a PCMH.
authors.affiliation: From Group Health Permanente, Seattle WA (BBG, LT); the Group Health Research Institute, Seattle WA (BBG, MLA, JC, SC); the University of Washington School of Medicine, Seattle (BBG, LMB, AC); the University of Washington School of Public Health, Seattle (JC); the University of California-Davis Betty Irene Moore School of Nursing, Sacramento (SC); and the University of Texas, Houston, School of Public Health, Houston (SWV). green.b@ghc.org.
authors.forename: Beverly B
authors.initials: BB
authors.lastname: Green
authors.affiliation: From Group Health Permanente, Seattle WA (BBG, LT); the Group Health Research Institute, Seattle WA (BBG, MLA, JC, SC); the University of Washington School of Medicine, Seattle (BBG, LMB, AC); the University of Washington School of Public Health, Seattle (JC); the University of California-Davis Betty Irene Moore School of Nursing, Sacramento (SC); and the University of Texas, Houston, School of Public Health, Houston (SWV).
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.affiliation: From Group Health Permanente, Seattle WA (BBG, LT); the Group Health Research Institute, Seattle WA (BBG, MLA, JC, SC); the University of Washington School of Medicine, Seattle (BBG, LMB, AC); the University of Washington School of Public Health, Seattle (JC); the University of California-Davis Betty Irene Moore School of Nursing, Sacramento (SC); and the University of Texas, Houston, School of Public Health, Houston (SWV).
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.affiliation: From Group Health Permanente, Seattle WA (BBG, LT); the Group Health Research Institute, Seattle WA (BBG, MLA, JC, SC); the University of Washington School of Medicine, Seattle (BBG, LMB, AC); the University of Washington School of Public Health, Seattle (JC); the University of California-Davis Betty Irene Moore School of Nursing, Sacramento (SC); and the University of Texas, Houston, School of Public Health, Houston (SWV).
authors.forename: Laura Mae
authors.initials: LM
authors.lastname: Baldwin
authors.affiliation: From Group Health Permanente, Seattle WA (BBG, LT); the Group Health Research Institute, Seattle WA (BBG, MLA, JC, SC); the University of Washington School of Medicine, Seattle (BBG, LMB, AC); the University of Washington School of Public Health, Seattle (JC); the University of California-Davis Betty Irene Moore School of Nursing, Sacramento (SC); and the University of Texas, Houston, School of Public Health, Houston (SWV).
authors.forename: Leah
authors.initials: L
authors.lastname: Tuzzio
authors.affiliation: From Group Health Permanente, Seattle WA (BBG, LT); the Group Health Research Institute, Seattle WA (BBG, MLA, JC, SC); the University of Washington School of Medicine, Seattle (BBG, LMB, AC); the University of Washington School of Public Health, Seattle (JC); the University of California-Davis Betty Irene Moore School of Nursing, Sacramento (SC); and the University of Texas, Houston, School of Public Health, Houston (SWV).
authors.forename: Sheryl
authors.initials: S
authors.lastname: Catz
authors.affiliation: From Group Health Permanente, Seattle WA (BBG, LT); the Group Health Research Institute, Seattle WA (BBG, MLA, JC, SC); the University of Washington School of Medicine, Seattle (BBG, LMB, AC); the University of Washington School of Public Health, Seattle (JC); the University of California-Davis Betty Irene Moore School of Nursing, Sacramento (SC); and the University of Texas, Houston, School of Public Health, Houston (SWV).
authors.forename: Alison
authors.initials: A
authors.lastname: Cole
authors.affiliation: From Group Health Permanente, Seattle WA (BBG, LT); the Group Health Research Institute, Seattle WA (BBG, MLA, JC, SC); the University of Washington School of Medicine, Seattle (BBG, LMB, AC); the University of Washington School of Public Health, Seattle (JC); the University of California-Davis Betty Irene Moore School of Nursing, Sacramento (SC); and the University of Texas, Houston, School of Public Health, Houston (SWV).
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods*; D013048:Specimen Handling / Q000379:methods*; D014861:Washington
keywords: Cancer Screening; Colon Cancer; Medical Home