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Physicians' Recommendations for Guideline Consistent Colorectal Cancer Screening

Presentation and supplemental tables for: Yabroff KR, Klabunde CN, Yuan G, McNeel TS, Brown ML, Casciotti D, Buckman DW, Taplin S. Are physicians' recommendations for colorectal cancer screening guideline-consistent?

Presentation Slides

Download the slides for the presentation entitled "Are Primary Care Physicians' Recommendations for Colorectal Cancer Screening Guideline-Consistent?" (PDF, 175 KB), presented to the American Public Health Association by Dr. K. Robin Yabroff on November 10, 2009.

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Supplementary Tables. Full Model Fit & Bootstrap Evaluation of Variable Selection Procedure for Multivariate Model

Table A. Full Model Fit

  Guideline consistent screening recommendations p-value
All guideline consistent vs. none Some guideline consistent vs. none
OR 95% CI OR 95% CI
Physician background and experience
Age
<40 1.00   1.00   <0.001
40-49 0.56 (0.35, 0.89) 0.81 (0.52, 1.27)
50-59 0.40 (0.23, 0.68) 0.68 (0.41, 1.12)
≥ 60 0.18 (0.09, 0.36) 0.40 (0.23, 0.71)
Gender
Male 1.00   1.00   0.002
Female 0.95 (0.63, 1.41) 1.63 (1.20, 2.21)
Race
White, non-Hispanic 1.00   1.00   0.645
Other 0.83 (0.53, 1.30) 0.99 (0.67, 1.46)
International medical school graduate
Yes 1.00   1.00   0.119
No 1.87 (1.03, 3.39) 1.24 (0.82, 1.87)
Board certification
Yes 1.92 (1.11, 3.33) 1.45 (1.02, 2.07) 0.029
No 1.00   1.00  
Medical school affiliation
Yes 1.26   1.32   0.152
No 1.00 (0.89, 1.79) 1.00 (0.98, 1.77)
Specialty
Family Practice/General Practice 1.00   1.00   0.126
Internal Medicine 0.65 (0.42, 1.02) 0.73 (0.52, 1.04)
Obstetrics Gynecology 0.74 (0.47, 1.15) 0.65 (0.42, 0.99)
Practice environment and practice patterns
Practice type
Solo Practice 1.00   1.00   <0.001
Single specialty group 2.95 (1.58, 5.51) 1.70 (1.12, 2.57)
Multi-specialty group 4.56 (2.44, 8.51) 1.46 (0.95, 2.23)
Other 1.93 (0.50, 7.51) 0.68 (0.21, 2.22)
Region
Northeast 0.64 (0.39, 1.04) 0.95 (0.66, 1.37) 0.009
North central 1.50 (0.94, 2.37) 1.44 (1.02, 2.03)
South 1.00   1.00  
West 1.09 (0.71, 1.67) 1.01 (0.67, 1.51)
Number of patients per week
<76 1.00   1.00   0.014
76-100 0.78 (0.49, 1.24) 1.07 (0.71, 1.61)
≥101 0.46 (0.29, 0.74) 0.96 (0.64, 1.42)
Record systems
Paper charts 1.00   1.00   0.008
Partial EMR/transition to EMR 1.48 (0.93, 2.35) 1.17 (0.78, 1.73)
Full EMR 2.31 (1.49, 3.58) 1.48 (0.99, 2.22)
Number of CRC screening modalities recommended
1 or 2 1.00   1.00   <0.001
3 or 4 1.00 (0.58, 1.73) 3.43 (2.31, 5.08)
Physician perceptions of colorectal cancer screening
Availability of third party reimbursement
Very influential 1.64 (0.93, 2.89) 1.12 (0.73, 1.71) 0.146
Somewhat influential 1.36 (0.92, 1.99) 1.29 (0.99, 1.70)
Not influential 1.00   1.00  
Patients' preferences for CRC screening
Very influential 1.93 (1.16, 3.21) 1.97 (1.19, 3.25) 0.019
Somewhat influential 1.36 (0.89, 2.08) 1.72 (1.14, 2.60)
Not influential 1.00   1.00  
Patient barriers to screening (composite measure)
Low (<8) 1.00   1.00   0.211
Intermediate (8-9) 1.60 (0.99, 2.59) 1.24 (0.88, 1.75)
High (≥10) 1.01 (0.58, 1.74) 1.03 (0.68, 1.55)
Shortage of trained providers
Yes 0.76 (0.42, 1.37) 1.07 (0.72, 1.59) 0.515
No 1.00   1.00  
Insufficient time to discuss screening
Yes 0.83 (0.54, 1.27) 0.88 (0.65, 1.21) 0.618
No 1.00   1.00  
Physician social support and influence
Clinical evidence in published literature
Very or somewhat influential 3.20 (0.78, 13.12) 3.70 (1.34, 10.22) 0.031
All other 1.00   1.00  
Local CRC screening practice
Very influential 0.47 (0.25, 0.86) 0.53 (0.35, 0.79) 0.008
Somewhat influential 0.52 (0.35, 0.77) 0.76 (0.56, 1.04)
Not influential 1.00   1.00  
US Preventive Services Task Force guidelines
Very influential 1.77 (0.63, 4.98) 0.98 (0.56, 1.74) 0.441
Somewhat influential 1.46 (0.48, 4.42) 1.16 (0.66, 2.03)
Not influential 1.00   1.00  
American Cancer Society guidelines
Very influential 0.66 (0.23, 1.91) 1.05 (0.51, 2.15) 0.408
Somewhat influential 0.69 (0.23, 2.04) 0.78 (0.36, 1.69)
Not influential 1.00   1.00  

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Table B. Bootstrap Evaluation of Variable Selection Procedure for Multivariate Model

Measure is hypothesis generating   Selected for multivariate model Associated with guideline-consistent screening at p<0.05 Percentage of bootstrap samples (N=200) variable selected
Physician background and experience
  Age X (forced) X 100% (forced)
  Gender X (forced) X 100% (forced)
X Race/ethnicity     20.5%
  International medical school graduate X   57%
X Board certification X (forced) X 100% (forced)
  Medical school affiliation X (forced)   100% (forced)
  Specialty X (forced)   100% (forced)
Practice environment and practice patterns
X Practice type X X 98.5%
X Region X X 73%
X Number of patients per week X X 80.5%
X Record systems X X 74%
X Number of CRC screening modalities recommended X X 100%
Physician perceptions of colorectal cancer screening
X Patients preferences for crc screening X X 72%
X Patient barriers to screening (composite measure) X   48.5%
X Availability of reimbursement X   45%
X Not enough time to discuss screening     14%
X Shortage of providers     22.5%
Physician social support and influence
X Clinical evidence in published literature influential X X 73%
X Local CRC screening practice influential X X 84.5%
X USPSTF guidelines influential     16.5%
X ACS guidelines influential     26%

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Last Modified: 03 Sep 2013