ASPO Abstracts
Patient centered medical homes and colorectal cancer screening in Hispanic and non-Hispanic White Medicaid patients
Category: Cancer Health Disparities, Cancer Health Disparities
Conference Year: 2018
Abstract Body:
Background Screening for colorectal cancer (CRC) remains widely underutilized despite CRC being the 3rd leading cause of cancer death in the U.S. Only 36% of Medicaid recipients, compared to 62% of eligible U.S. adults, are up-to-date with CRC screening guidelines. This study explored the effect of patient centered medical homes (PCMH) and race/ethnicity on CRC screening among Medicaid recipients. Methods We obtained Oregon Medicaid data (2013-2015) that included monthly enrollment, demographics, and claims data for all medical encounters. Inclusion criteria were: newly eligible for CRC screening (age 50 between January 2013 to June 2014), continuously enrolled in Medicaid (for 11 months following the 50th birthday), and alive during the study period. Excluded members were those dually enrolled in Medicare and with end-stage renal disease. We used logistic regression to examine the effect of PCMH on receipt of any CRC screening (colonoscopy or stool blood test) and on screening modality. We examined interaction effects of PCMH and race/ethnicity on both outcomes. Results We analyzed data for 3,256 Medicaid patients: 88% White and 12% Hispanic. Overall, 22.8% received any CRC screening. Among those screened, 67% (n=498) received a colonoscopy and 33% (n = 242) a stool blood test. Patients were attributed to 443 primary care clinics: 60% were designated as a PCMH. Analyses revealed that patients attending PCMH clinics had lower odds of any CRC screening compared to patients in non-PCMH clinics (OR 0.80; CI .67-.96). Other significant variables included patients with > 1 comorbid condition and number of clinic providers. There was no effect of PCMH status on screening modality. There was a significant interaction of race and gender with screening modality (OR 0.41; CI .23, .74) but not with any CRC screening (OR .07; CI 0.4, 1.04). Conclusion Although PCMH clinics have the potential to decrease barriers to CRC screening, being a patient in a PCMH clinic did not result in higher CRC screening for our Medicaid population. Our results add to the mixed evidence in the literature regarding the benefits of PCMH with respect to CRC screening. Further research might examine specific features of a PCMH to determine which specific components, if any, are most effective
Keywords: colorectal cancer screening; cancer disparities; Hispanic/Latino; patient centered medical home