Multi-component interventions and change in screening rates in primary care clinics in the Colorectal Cancer Control...

Area of Science:

• Public Health
• Cancer Prevention
• Health Services Research

Background:

• Colorectal cancer (CRC) screening reduces mortality.
• Evidence-based interventions (EBIs) are crucial for increasing CRC screening rates.
• The Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP) aims to improve screening.

Purpose of the Study:

• To identify which combinations of EBIs or strategies most effectively increase clinic-level CRC screening rates.
• To analyze data from clinics participating in the CDC's CRCCP.
• To understand the impact of different EBI combinations on screening uptake.

Main Methods:

• Analysis of data from 486 unique clinics within the CRCCP (2015-2018).
• Utilized a first difference (FD) estimator of a linear panel data regression model.
• Outcome variable: annual change in clinic-level CRC screening rate (percentage points).

Main Results:

• Combinations of three or four EBIs showed significant increases in screening rates, with the largest increase being 7.2 percentage points (P < 0.001).
• Combinations of 2-3 strategies, particularly increasing community demand and access, led to significant increases (6.1 percentage points, P < 0.001).
• Clinics using multiple EBIs, especially three or more, were more likely to show improved screening rates compared to those using none.

Conclusions:

• Implementing combinations of EBIs, particularly those involving three or more interventions, is highly effective in increasing colorectal cancer screening rates.
• Strategic combinations of interventions, such as enhancing community demand and access, demonstrate significant positive impacts on screening uptake.
• The findings support the adoption of multi-component EBI strategies within public health programs to maximize CRC screening effectiveness.