Table 5.
Association Between Facility Characteristics and Receipt of a Potentially Inappropriate FOBT or Screening Colonoscopy by Reason Type, Controlling for Patient Characteristics*
| Any Reason OR (95 % CI) | Not Due OR (95 % CI) | Limited Life Expectancy OR (95 % CI) | Wrong Test OR (95 % CI) | |
|---|---|---|---|---|
| FOBT | ||||
| Complexity score (vs. lower third) | ||||
| Middle third | 0.95 (0.80, 1.12) | 0.92 (0.72, 1.17) | 1.04 (0.95, 1.14) | 0.97 (0.84, 1.11) |
| Upper third | 0.90 (0.76, 1.07) | 0.84 (0.66, 1.07) | 1.12 (1.02, 1.23) | 0.90 (0.78, 1.04) |
| CRC screening performance score (vs. lower third) | ||||
| Middle third | 0.93 (0.79, 1.09) | 0.87 (0.69, 1.10) | 0.99 (0.90, 1.09) | 0.99 (0.86, 1.13) |
| Upper third | 1.03 (0.87, 1.22) | 1.07 (0.84, 1.37) | 0.98 (0.89, 1.07) | 0.94 (0.81, 1.08) |
| Percent screening completed with FOBT (vs. lower third) | ||||
| Middle third | 0.90 (0.77, 1.06) | 0.90 (0.71, 1.14) | 0.88 (0.80, 0.97) | 0.85 (0.74, 0.97) |
| Upper third | 0.78 (0.67, 0.92) | 0.70 (0.55, 0.88) | 0.91 (0.83, 0.99) | 0.79 (0.69, 0.91) |
| CR promotes FOBT over colonoscopy | 0.86 (0.61, 1.20) | 0.87 (0.53, 1.43) | 0.87 (0.72, 1.06) | 0.89 (0.67, 1.19) |
| CR asks provider to enter elements of patient’s family history | 1.08 (0.82, 1.41) | 1.14 (0.77, 1.68) | 0.92 (0.79, 1.07) | 0.98 (0.77, 1.23) |
| CR can be turned off by provider | 0.91 (0.76, 1.09) | 0.99 (0.76, 1.29) | 0.97 (0.87, 1.08) | 0.83 (0.71, 0.97) |
| CR allows provider to specify timing of next colonoscopy | 1.04 (0.86, 1.25) | 1.03 (0.79, 1.35) | 0.99 (0.89, 1.10) | 1.09 (0.93, 1.28) |
| CR contains a general ‘not indicated’ option | 1.04 (0.89, 1.20) | 1.08 (0.87, 1.35) | 0.98 (0.90, 1.07) | 1.08 (0.95, 1.23) |
| CR includes patient screening decision education | 0.86 (0.71, 1.04) | 0.79 (0.60, 1.05) | 1.03 (0.92, 1.15) | 0.88 (0.75, 1.04) |
| CR completion assigned to (vs. intake nurse only): | ||||
| Primary care provider only | 1.10 (0.86, 1.39) | 1.18 (0.84, 1.67) | 1.11 (0.97, 1.26) | 1.06 (0.87, 1.30) |
| Both primary care provider and intake nurse | 1.10 (0.88, 1.37) | 1.13 (0.82, 1.56) | 1.16 (1.02, 1.31) | 1.08 (0.90, 1.31) |
| COLONOSCOPY | ||||
| Complexity score (vs. lower third) | ||||
| Middle third | 1.29 (1.03, 1.60) | 1.35 (1.04, 1.76) | 1.20 (1.02, 1.41) | |
| Upper third | 1.09 (0.87, 1.37) | 1.01 (0.78, 1.32) | 1.37 (1.17, 1.61) | |
| CRC screening performance score (vs. lower third) | ||||
| Middle third | 1.23 (0.99, 1.52) | 1.23 (0.95, 1.60) | 1.13 (0.97, 1.32) | |
| Upper third | 1.20 (0.96, 1.51) | 1.34 (1.02, 1.75) | 0.88 (0.75, 1.03) | |
| Percent screening completed with FOBT (vs. lower third) | ||||
| Middle third | 1.32 (1.11, 1.57) | 1.45 (1.17, 1.82) | 1.07 (0.92, 1.23) | |
| Upper third | 2.20 (1.84, 2.62) | 2.34 (1.87, 2.93) | 1.47 (1.27, 1.71) | |
| CR promotes FOBT over colonoscopy | 1.11 (0.71, 1.76) | 1.33 (0.77, 2.30) | 0.93 (0.66, 1.31) | |
| CR asks provider to enter elements of patient’s family history | 0.96 (0.67, 1.37) | 1.03 (0.67, 1.58) | 0.88 (0.68, 1.14) | |
| CR can be turned off by provider | 1.06 (0.83, 1.35) | 1.18 (0.88, 1.58) | 0.89 (0.74, 1.06) | |
| CR allows provider to specify timing of next colonoscopy | 0.81 (0.63, 1.04) | 0.81 (0.60, 1.10) | 0.90 (0.75, 1.08) | |
| CR contains a general ‘not indicated’ option | 0.88 (0.72, 1.07) | 0.93 (0.73, 1.18) | 0.83 (0.72, 0.97) | |
| CR includes patient screening decision education | 1.19 (0.92, 1.55) | 1.20 (0.88, 1.65) | 1.14 (0.94, 1.39) | |
| CR completion assigned to (vs. intake nurse only): | ||||
| Primary care provider only | 0.73 (0.53, 0.99) | 0.70 (0.48, 1.02) | 0.85 (0.67, 1.06) | |
| Both primary care provider and intake nurse | 0.74 (0.55, 0.99) | 0.69 (0.48, 0.97) | 0.95 (0.76, 1.18) | |
CRC Colorectal cancer; CR Clinical reminder; FOBT Fecal occult blood test
* Odds ratio (95 % confidence interval) adjusted for clustering of patients within facilities, controlled for patient age, gender, race, ethnicity, and marital status