Degree

Doctor of Philosophy (PhD)

Department

Environmental Sciences

Document Type

Dissertation

Abstract

To help control the spread of coronavirus disease 2019 (COVID-19), health care organizations suspended nonessential medical procedures, including preventive cancer screening, in early 2020, with effects on cancer screening services lasting beyond the original restrictions. Many individuals canceled or postponed cancer screening, potentially delaying cancer diagnosis, and healthcare providers had differing policies, procedures, and priorities to address the pandemic, as well as varying levels of access to routine care, such as cancer screening. In contrast to earlier research on COVID-19 cancer screening deficits, this research quantified declines at the Medicare Fee-for-Service provider level and constructed models to predict the counterfactual level of screening for 2020 and 2021. The resilience of providers in four cancer screening lines- cervical, colorectal lab, colorectal procedure, and prostate cancer screenings- was determined, and it was found that 2,626 of 18,808 providers (14%) were resilient during both 2020 and 2021. By year, 4,921 (26%) were resilient in either 2020 (963) or 2021 (3,958), and 11,261 (60%) were not resilient in either year.

In the examination of explainable variation in a county-level model of the ratio of 2020-2021 observed beneficiaries to predicted beneficiaries (Resilient Beneficiary Index), characteristics aligned with providers’ practices were the most contributory domain, accounting for 48%. The next most contributory domains were Social Determinants of Health (SDOH), at 30%, COVID restrictive measures at 18%, and county-level demographics at 4%, with a significant portion of the variability yet to be explained. Further research may refine and extend these findings.

Date

1-9-2026

Committee Chair

Wilson, Vincent L.

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Available for download on Monday, January 08, 2029

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