Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System
Background Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. Objective To examine the association between race/ethnicity and the...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2016-11, Vol.31 (11), p.1323-1330 |
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| creator | Mehta, Shivan J. Jensen, Christopher D. Quinn, Virginia P. Schottinger, Joanne E. Zauber, Ann G. Meester, Reinier Laiyemo, Adeyinka O. Fedewa, Stacey Goodman, Michael Fletcher, Robert H. Levin, Theodore R. Corley, Douglas A. Doubeni, Chyke A. |
| description | Background
Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known.
Objective
To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program.
Design
Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004–2013).
Subjects
A total of 868,934 screen-eligible individuals 51–74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004–2006), 654,633 during the first 3 years after implementation (2007–2009), and 665,268 in the period from 4 to 7 years (2010–2013) after program implementation.
Intervention
A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits.
Main Measures
Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races.
Key Results
From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02–1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96–0.97). There were also substantial improvements in timely follow-up of positive screening results.
Conclusions
In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT. |
| doi_str_mv | 10.1007/s11606-016-3792-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5071288</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2001388688</sourcerecordid><originalsourceid>FETCH-LOGICAL-c536t-a2a85564be16b8b32f5ebcb13e3af8d3681e1084c58425ae7cf317a860ef216a3</originalsourceid><addsrcrecordid>eNp1kc9u1DAQhy0EokvhAbggS1y4hHqc2HEvSNuoUKQiEIWzNXEmu6kSO9gJ0r4DD022u5Q_EifLmt98M6OPsecgXoMQ5VkC0EJnAnSWl-cygwdsBUqqDIrz8iFbCWOKzJR5ccKepHQrBORSmsfsRJYFyELqFfvxGR2dXU5b37lu2nH0DV83YZy64HloOfJPYZx7vPtfEfbTln9AjxsayE98PY4xoNvyKfAq9CGSm7DnFXpHkd-4SOQ7v-GdX0hVGIbZL1OyC0zUHHEOI_GbXZpoeMoetdgnenZ8T9nXt5dfqqvs-uO799X6OnMq11OGEo1SuqgJdG3qXLaKaldDTjm2psm1AQJhCqdMIRVS6docSjRaUCtBY37K3hy441wP1Ljlkoi9HWM3YNzZgJ39u-K7rd2E71aJEqQxC-DVERDDt5nSZIcuOep79BTmZMFIXUpQZbFEX_4TvQ1z9Mt5Vu6FGKPvgHBIuRhSitTeLwPC7l3bg2u7uLZ71xaWnhd_XnHf8UvuEpCHQFpKfkPx9-j_U38C7wW2aw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2001388688</pqid></control><display><type>article</type><title>Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System</title><source>MEDLINE</source><source>SpringerLink Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Mehta, Shivan J. ; Jensen, Christopher D. ; Quinn, Virginia P. ; Schottinger, Joanne E. ; Zauber, Ann G. ; Meester, Reinier ; Laiyemo, Adeyinka O. ; Fedewa, Stacey ; Goodman, Michael ; Fletcher, Robert H. ; Levin, Theodore R. ; Corley, Douglas A. ; Doubeni, Chyke A.</creator><creatorcontrib>Mehta, Shivan J. ; Jensen, Christopher D. ; Quinn, Virginia P. ; Schottinger, Joanne E. ; Zauber, Ann G. ; Meester, Reinier ; Laiyemo, Adeyinka O. ; Fedewa, Stacey ; Goodman, Michael ; Fletcher, Robert H. ; Levin, Theodore R. ; Corley, Douglas A. ; Doubeni, Chyke A.</creatorcontrib><description>Background
Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known.
Objective
To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program.
Design
Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004–2013).
Subjects
A total of 868,934 screen-eligible individuals 51–74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004–2006), 654,633 during the first 3 years after implementation (2007–2009), and 665,268 in the period from 4 to 7 years (2010–2013) after program implementation.
Intervention
A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits.
Main Measures
Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races.
Key Results
From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02–1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96–0.97). There were also substantial improvements in timely follow-up of positive screening results.
Conclusions
In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-016-3792-1</identifier><identifier>PMID: 27412426</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aged ; Cancer ; Cancer screening ; Cohort Studies ; Colonoscopy - methods ; Colorectal cancer ; Colorectal carcinoma ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - ethnology ; Colorectal Neoplasms - prevention & control ; Communities ; Community Health Services - methods ; Continental Population Groups - ethnology ; Disease Management ; Early Detection of Cancer - methods ; Ethnic factors ; Ethnic Groups ; Ethnicity ; Female ; Follow-Up Studies ; Health care ; Health Services Accessibility ; Hispanic Americans ; Humans ; Internal Medicine ; Leadership ; Longitudinal Studies ; Male ; Medical screening ; Medicine ; Medicine & Public Health ; Middle Aged ; Minority & ethnic groups ; Native Americans ; Original Research ; Outreach programs ; Population Health ; Quality assurance ; Race ; Retrospective Studies ; Sigmoidoscopy - methods</subject><ispartof>Journal of general internal medicine : JGIM, 2016-11, Vol.31 (11), p.1323-1330</ispartof><rights>Society of General Internal Medicine 2016</rights><rights>Journal of General Internal Medicine is a copyright of Springer, (2016). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-a2a85564be16b8b32f5ebcb13e3af8d3681e1084c58425ae7cf317a860ef216a3</citedby><cites>FETCH-LOGICAL-c536t-a2a85564be16b8b32f5ebcb13e3af8d3681e1084c58425ae7cf317a860ef216a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071288/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071288/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27412426$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mehta, Shivan J.</creatorcontrib><creatorcontrib>Jensen, Christopher D.</creatorcontrib><creatorcontrib>Quinn, Virginia P.</creatorcontrib><creatorcontrib>Schottinger, Joanne E.</creatorcontrib><creatorcontrib>Zauber, Ann G.</creatorcontrib><creatorcontrib>Meester, Reinier</creatorcontrib><creatorcontrib>Laiyemo, Adeyinka O.</creatorcontrib><creatorcontrib>Fedewa, Stacey</creatorcontrib><creatorcontrib>Goodman, Michael</creatorcontrib><creatorcontrib>Fletcher, Robert H.</creatorcontrib><creatorcontrib>Levin, Theodore R.</creatorcontrib><creatorcontrib>Corley, Douglas A.</creatorcontrib><creatorcontrib>Doubeni, Chyke A.</creatorcontrib><title>Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known.
Objective
To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program.
Design
Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004–2013).
Subjects
A total of 868,934 screen-eligible individuals 51–74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004–2006), 654,633 during the first 3 years after implementation (2007–2009), and 665,268 in the period from 4 to 7 years (2010–2013) after program implementation.
Intervention
A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits.
Main Measures
Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races.
Key Results
From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02–1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96–0.97). There were also substantial improvements in timely follow-up of positive screening results.
Conclusions
In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.</description><subject>Aged</subject><subject>Cancer</subject><subject>Cancer screening</subject><subject>Cohort Studies</subject><subject>Colonoscopy - methods</subject><subject>Colorectal cancer</subject><subject>Colorectal carcinoma</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Colorectal Neoplasms - ethnology</subject><subject>Colorectal Neoplasms - prevention & control</subject><subject>Communities</subject><subject>Community Health Services - methods</subject><subject>Continental Population Groups - ethnology</subject><subject>Disease Management</subject><subject>Early Detection of Cancer - methods</subject><subject>Ethnic factors</subject><subject>Ethnic Groups</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health care</subject><subject>Health Services Accessibility</subject><subject>Hispanic Americans</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Leadership</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical screening</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minority & ethnic groups</subject><subject>Native Americans</subject><subject>Original Research</subject><subject>Outreach programs</subject><subject>Population Health</subject><subject>Quality assurance</subject><subject>Race</subject><subject>Retrospective Studies</subject><subject>Sigmoidoscopy - 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methods</topic><topic>Colorectal cancer</topic><topic>Colorectal carcinoma</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Colorectal Neoplasms - ethnology</topic><topic>Colorectal Neoplasms - prevention & control</topic><topic>Communities</topic><topic>Community Health Services - methods</topic><topic>Continental Population Groups - ethnology</topic><topic>Disease Management</topic><topic>Early Detection of Cancer - methods</topic><topic>Ethnic factors</topic><topic>Ethnic Groups</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health care</topic><topic>Health Services Accessibility</topic><topic>Hispanic Americans</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Leadership</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical screening</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minority & ethnic groups</topic><topic>Native Americans</topic><topic>Original Research</topic><topic>Outreach programs</topic><topic>Population Health</topic><topic>Quality assurance</topic><topic>Race</topic><topic>Retrospective Studies</topic><topic>Sigmoidoscopy - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mehta, Shivan J.</creatorcontrib><creatorcontrib>Jensen, Christopher D.</creatorcontrib><creatorcontrib>Quinn, Virginia P.</creatorcontrib><creatorcontrib>Schottinger, Joanne E.</creatorcontrib><creatorcontrib>Zauber, Ann G.</creatorcontrib><creatorcontrib>Meester, Reinier</creatorcontrib><creatorcontrib>Laiyemo, Adeyinka O.</creatorcontrib><creatorcontrib>Fedewa, Stacey</creatorcontrib><creatorcontrib>Goodman, Michael</creatorcontrib><creatorcontrib>Fletcher, Robert H.</creatorcontrib><creatorcontrib>Levin, Theodore R.</creatorcontrib><creatorcontrib>Corley, Douglas A.</creatorcontrib><creatorcontrib>Doubeni, Chyke A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mehta, Shivan J.</au><au>Jensen, Christopher D.</au><au>Quinn, Virginia P.</au><au>Schottinger, Joanne E.</au><au>Zauber, Ann G.</au><au>Meester, Reinier</au><au>Laiyemo, Adeyinka O.</au><au>Fedewa, Stacey</au><au>Goodman, Michael</au><au>Fletcher, Robert H.</au><au>Levin, Theodore R.</au><au>Corley, Douglas A.</au><au>Doubeni, Chyke A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>31</volume><issue>11</issue><spage>1323</spage><epage>1330</epage><pages>1323-1330</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known.
Objective
To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program.
Design
Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004–2013).
Subjects
A total of 868,934 screen-eligible individuals 51–74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004–2006), 654,633 during the first 3 years after implementation (2007–2009), and 665,268 in the period from 4 to 7 years (2010–2013) after program implementation.
Intervention
A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits.
Main Measures
Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races.
Key Results
From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02–1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96–0.97). There were also substantial improvements in timely follow-up of positive screening results.
Conclusions
In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27412426</pmid><doi>10.1007/s11606-016-3792-1</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2016-11, Vol.31 (11), p.1323-1330 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5071288 |
| source | MEDLINE; SpringerLink Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Aged Cancer Cancer screening Cohort Studies Colonoscopy - methods Colorectal cancer Colorectal carcinoma Colorectal Neoplasms - diagnosis Colorectal Neoplasms - ethnology Colorectal Neoplasms - prevention & control Communities Community Health Services - methods Continental Population Groups - ethnology Disease Management Early Detection of Cancer - methods Ethnic factors Ethnic Groups Ethnicity Female Follow-Up Studies Health care Health Services Accessibility Hispanic Americans Humans Internal Medicine Leadership Longitudinal Studies Male Medical screening Medicine Medicine & Public Health Middle Aged Minority & ethnic groups Native Americans Original Research Outreach programs Population Health Quality assurance Race Retrospective Studies Sigmoidoscopy - methods |
| title | Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T06%3A50%3A44IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Race/Ethnicity%20and%20Adoption%20of%20a%20Population%20Health%20Management%20Approach%20to%20Colorectal%20Cancer%20Screening%20in%20a%20Community-Based%20Healthcare%20System&rft.jtitle=Journal%20of%20general%20internal%20medicine%20:%20JGIM&rft.au=Mehta,%20Shivan%20J.&rft.date=2016-11-01&rft.volume=31&rft.issue=11&rft.spage=1323&rft.epage=1330&rft.pages=1323-1330&rft.issn=0884-8734&rft.eissn=1525-1497&rft_id=info:doi/10.1007/s11606-016-3792-1&rft_dat=%3Cproquest_pubme%3E2001388688%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2001388688&rft_id=info:pmid/27412426&rfr_iscdi=true |