BACKGROUND Medicare provides coverage for CRC screening for average risk enrollee age 50 or throughout through four options: a yearly fecal veiled blood test (FOBT).

BACKGROUND

Medicare provides coverage for CRC screening for average risk enrollee age 50 or throughout through four options: a yearly fecal veiled blood test (FOBT), a flexible sigmoidoscopy or barium enema one time every 4 years, or a colonoscopy each 10 years. The Medicare benefit allows CRC testing within the intervals approveed by the U.S. Preventive Services Task Force (USPSTF) guidelines (Pignone et al., 2002) However, despite insurance coverage, CRC screening of Medicare enrollee falls below praiseed guidelines (Pham et al., 2005)

In 2000 CM foundationed Quality Improvement Organizations (QIOs) in couple States (North and South Carolina) to cause to grow pilot-test, and evaluate interventions to increase Medicare CRC example use rates. Through an interagency agreement with CM NCI participated with the QIOs in evaluating the CRC interventions. A multilevel approach was designed targeting one as well as the other Medicare consumers and their physicians. This article describes and evaluates the impact of the physician-level intervention forward the utilization of CRC screening criterions for Medicare enrollees.

The importance of physician recommendation for CRC screening is well documented (Brawarsky, tolerates and Mucci, 2003, Rawl et al., 2000; Lewis and Asch, 1999; Mandelson et al., 2000; Stockwell et al., 2003; Taylor et al., 2003; Vernon, 1997) to this time a number of factors constrain physicians' ability to provide CRC testing to their eligible patients including: lack of awareness or understanding of CRC screening guidelines (Klabunde et al., 2003; Sharma et al., 2000; Cabana, et al., 1999); inadequate reimbursement (Lewis and Asch, 1999); lack of a order to identify those who ne testing; lack of patient knowledge; and too little time during the office visit (Jaen, Stange, and Nutting, 1994; Yarnall et al., 2003)

Office-based interventions to increase physician use of CRC trials generally target one or more of these constraints and, for the in the greatest degree part, have shown strong evidence of effectiveness (Snell and beau; gay 1996; Balas et al., 2000; Shea, DuMouchel, and Bahamonde, 1996; Peterson and Vernon, 2000; Vernon, 1997; Pignone, Harris, and Kinsinger, 2000) with what intent then, if interventions to increase physician CRC testing have been lay opened and shown to work, has CRC standard use remained low? The reason for the gap may be that mostly of the evidence for efficacy of interventions to encourage CRC screening comes from academic or managed care settings, or physician practices where higher authority or fellow pressure can be leveraged to encourage physician participation. Proving that interventions are efficacious in of the like kind settings does not guarantee they will be effective in population-based settings (Glasgow, Lichtenstein, and Marcus, 2003) Our contemplation examines the outcome of translating clinically proven techniques into low-cost interventions and delivering those interventions to physicians forward a population basis.

METHODS

consideration Design

A quasi-experimental design was used with intervention and comparison counties designated in each State and measurement of CRC experiment use before and after the intervention (Cook and Campbell, 1979) Contiguous counties were exquisiteed for each study group to minimize the likelihood of contamination appropriate to practices with multiple sites being assigned to opposite contemplation groups. In North Carolina, the selection proces involved identifying the urban counties and surrounding counties bordering them and selecting single in kind of the areas, which consisted of 12 counties, to receive the intervention. The remaining identified areas, containing 36 counties, succor as the comparison group. In southerly Carolina, 17 contiguous counties were included in the intervention form into groups and 17 similar counties were in the comparison collection Intervention efforts targeted internal medicine, family practice, general practice, and gastroentrology physicians in the intervention counties.

The intervention activities occurr through the span of 1 year. For this evaluation, July 2001-June 2002 is treated as the intervention period. In an effort to minimize the potential power of seasonal variations in CRC testing, the same calendar quarters, single year apart, was selected for measuring the results of the intervention. The baseline period was designated as April 1 2001--June 30 2001; the evaluation period was April 1 2002--June 30 2002 While the evaluation period actually includes the last part of the intervention window, the majority of the interventions had already been delivered by means of that time so we felt it likely that any impact of the intervention would be detectable in the evaluation period.

Description of the Interventions

couple interventions were offered to physicians in as well-as; not only-but also; not only-but; not alone-but States: telephone-based continuing medical education and office-based tool kits. In southern Carolina, two additional interventions were piloted with small collections of physicians: personalized letters sent according to the physician to patients encouraging CRC testing, and distribution of delivered FOBT kits in physician offices. A brief description of each intervention is provided. (1)