Online Program

333566
Patient characteristics, healthcare utilization practices and rural-urban residence associated with accurate self-report of up-to-date colorectal cancer screening by colonoscopy


Monday, November 2, 2015

Carol Moss, MS, Department of Family Medicine, University of Iowa, Iowa City, IA
Charles Lynch, MD, MS, PhD, College of Public Health, University of Iowa, Iowa City, IA
Trudy Burns, MPH, PhD, College of Public Health, University of Iowa, Iowa City, IA
Ryan Carnahan, PharmD, MS, College of Public Health, University of Iowa, Iowa City, IA
Barcey Levy, PhD, MD, Department of Family Medicine, University of Iowa, Iowa City, IA
Background/Objective:  Self-report of colorectal cancer (CRC) screening remains a critical source of information in determining adherence to recommended guidelines. Population subgroup differences can affect self-report accuracy and contribute to error. We calculated one common validity measure, concordance, and evaluated associations with predictor variables.  

Methods: 1,399 patients, aged 51-80, from 16 Midwestern family medicine offices, completed an investigator-developed questionnaire. We compared self-report of up-to-date screening with test documentation in the medical record to measure concordance. Patient's place of residence was categorized according to Rural Urban Commuting Area (RUCA) codes ("metropolitan" [population 50,000+], "large rural" [10,000-49,999], "small town" [2,500-9,999] or "rural area" [<2,500]). Multivariable analysis assessed predictors of concordance.

Results: 48% of patients had screening documented in the medical record; 98% had a colonoscopy. Concordance for colonoscopy was good (0.84). Education (<high school diploma vs. diploma, OR=0.40, 95% CI 0.21-0.76), insurance source (military service-connected vs. employer, OR=0.19, CI 0.08-0.45; Medicare with or without supplement vs. employer, OR=0.57, CI 0.33-0.98), CRC family history (yes vs. no, OR=0.60, CI 0.39-0.91) and patient duration in office (<1 year vs. 1-25 years, OR=0.22, CI 0.05-0.98) were significant predictors of concordance. As age increased, recent provider visit demonstrated significant (p=0.03) association between place of residence and concordance: at age 55, the small town resident's report was associated with concordance greater than three times that of the metropolitan resident's; at 75, reports of both rural area and large rural residents were associated with concordance at about one-third that of metropolitan residents'.

Conclusion: Concordance between self-reported colonoscopy and evidence in the medical record was good but varied with patient characteristics, healthcare utilization practices and rural-urban residence.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Identify patient variables that are significantly associated with accurate self-report of up-to-date colorectal cancer screening by colonoscopy. Explain the modifying effect of age on the association between place of residence and accuracy of self-report and recent provider visit and accuracy of self-report.

Keyword(s): Cancer Prevention and Screening, Practice-Based Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am responsible for implementing funded projects that are part of the University of Iowa Department of Family Medicine's research endeavor, focusing on the prevention of chronic disease.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.