Primary Care Provider Perceptions of Colorectal Cancer Screening Barriers: Implications for Designing Quality Improvement Interventions.
Aims. Colorectal cancer (CRC) screening is underutilized. Increasing CRC screening rates requires interventions targeting multiple barriers at each level of the healthcare organization (patient, provider, and system). We examined groups of primary care providers (PCPs) based on perceptions of screening barriers and the relationship to CRC screening rates to inform approaches for conducting barrier assessments prior to designing and implementing quality improvement interventions.Methods. We conducted a retrospective cohort study linking EHR and survey data. PCPs with complete survey responses for questions addressing CRC screening barriers were included (N= 166 PCPs; 39,430 patients eligible for CRC screening). Cluster analysis identified groups of PCPs. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for predictors of membership in one of the PCP groups.Results. We found two distinct groups: (1) PCPs identifying multiple barriers to CRC screening at patient, provider, and system levels (N= 75) and (2) PCPs identifying no major barriers to screening (N= 91). PCPs in the top half of CRC screening performance were more likely to identify multiple barriers than the bottom performers (OR, 4.14; 95% CI, 2.43-7.08).Conclusions. High-performing PCPs can more effectively identify CRC screening barriers. Targeting high-performers when conducting a barrier assessment is a novel approach to assist in designing quality improvement interventions for CRC screening.
Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
Jennifer M
0000-0002-4927-2133
JM
Weiss
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Perry J
PJ
Pickhardt
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Jessica R
JR
Schumacher
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Aaron
A
Potvien
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
David H
DH
Kim
Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Patrick R
PR
Pfau
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Elizabeth A
EA
Jacobs
University of Wisconsin Carbone Cancer Center, Madison, WI, USA; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Maureen A
MA
Smith