The Impact of the Patient Centered Medical Home on Colorectal Cancer Screening in a Navy Primary Care Clinic

Abstract

Background: Colorectal cancer (CRC) is the second leading cause of cancer death among men and among women. Even though available screening tests are effective at decreasing incidence of and deaths from CRC, use of CRC screening is still inadequate. Nationally, the CRC screening rate is only 68% among eligible patients for medical facilities in the top 10% for CRC screening. The Patient Centered Medical Home (PCMH) is a team–based model of care that purports to improve access to care, patient satisfaction, and performance of cancer screening and other preventive measures. Methods: This retrospective cohort study was designed to test the hypothesis that implementation of the PCMH is associated with an increase in CRC screening rates in patients enrolled to PCMH care teams compared to those in non–PCMH care teams. All eligible patients, age 51–75, enrolled to a Navy primary care clinic were included (3,519 patients in 2007, and 4,120 in 2011). Data were analyzed comparing baseline to post–implementation time points for PCMH teams and non–PCMH teams in the clinic. Results: All teams improved CRC screening completion from baseline, with PCMH teams outperforming non–PCMH teams in rate of completion (adjusted odds ratio (OR) =1.30, p=0.001) and rate of patients never screened (adjusted OR = 0.77, p=0.001). Conclusion: The study shows that PCMH implementation was associated with improved CRC screening.