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Le A, Wheeler SB, Lafata JE, Teal R, Giannone K, Smith LS, Zaffino M, Smith JS. Self-Collection for HPV Testing: Potential Issues Related to Performance Measures and Quality Improvement Among Federally Qualified Health Centers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:688-700. [PMID: 38985535 DOI: 10.1097/phh.0000000000001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
CONTEXT Most incident cases of cervical cancer in the United States are attributable to inadequate screening. Federally qualified health centers (FQHCs) serve a large proportion of women who are low-income, have no insurance, and are underserved-risk factors for insufficient cervical cancer screening. FQHCs must maintain quality measures to preserve their accreditation, address financial reimbursements, and provide quality care. Implementation of human papillomavirus (HPV) self-collection can improve cervical cancer screening coverage within FQHCs. OBJECTIVES To understand perspectives from clinical personnel on current cervical cancer screening rates at FQHCs in North Carolina and the impact of implementing HPV self-collection among underscreened patients on screening rates and performance measures. DESIGN The study used focus groups and key informant interviews. Coding-based thematic analysis was applied to both focus group and interview transcripts. Emergent themes regarding perspectives on self-collection implementation were mapped onto Consolidated Framework for Implementation Research (CFIR) constructs to identify future barriers and facilitators to implementation. SETTING Two FQHCs in North Carolina and a cloud-based videoconferencing platform. PARTICIPANTS Six FQHCs in North Carolina; 45 clinical and administrative staff from the 6 FQHCs; 1 chief executive officer (n = 6), 1 senior-level administrator (n = 6), 1 chief medical officer (n = 6), and 1 clinical data manager (n = 6) from each FQHC. MAIN OUTCOME MEASURE Achievement of clinical perspectives. RESULTS Societal-, practice-, and patient-level factors currently contribute to subpar cervical cancer screening rates. HPV self-collection was expected to improve screening uptake among underscreened women at FQHCs, and thus quality and performance measures, by offering an alternative screening approach for in-clinic or at-home use. Implementation barriers include financial uncertainties and HPV self-collection not yet a Food and Drug Administration-approved test. CONCLUSION HPV self-collection has potential to improve cervical cancer screening quality and performance measures of FQHCs. For a successful implementation, multilevel factors that are currently affecting low screening uptake need to be addressed. Furthermore, the financial implications of implementation and approval of HPV self-collection as a test for cervical cancer screening quality measures need to be resolved.
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Affiliation(s)
- Amanda Le
- Departments of Public Health Leadership (Ms Le and Dr L. S. Smith), Health Policy and Management (Dr Wheeler), and Epidemiology (Dr J. S. Smith), Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center (Drs Wheeler, Lafata, and J. S. Smith, Mr Teal, and Ms Giannone), Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy (Dr Lafata), and Connected Health Applications and Interventions (CHAI-Core) (Mr Teal and Ms Giannone), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Blue Ridge Health, Hendersonville, North Carolina (Dr Zaffino)
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Gautom P, Rosales AG, Petrik AF, Thompson JH, Slaughter MT, Mosso L, Hussain SA, Jimenez R, Coronado GD. Evaluating the Reach of a Patient Navigation Program for Follow-up Colonoscopy in a Large Federally Qualified Health Center. Cancer Prev Res (Phila) 2024; 17:325-333. [PMID: 38641422 PMCID: PMC11219256 DOI: 10.1158/1940-6207.capr-23-0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/28/2024] [Accepted: 04/05/2024] [Indexed: 04/21/2024]
Abstract
Patient navigation (PN) has been shown to improve participation in cancer screening, including colorectal cancer screening, and is now a recommended practice by the Community Preventive Services Task Force. Despite the effectiveness of PN programs, little is known about the number of contacts needed to successfully reach patients or about the demographic and healthcare utilization factors associated with reach. PRECISE was an individual randomized study of PN versus usual care conducted as a partnership between two large health systems in the Pacific Northwest. The navigation program was a six-topic area telephonic program designed to support patients with an abnormal fecal test result to obtain a follow-up colonoscopy. We report the number of contact attempts needed to successfully reach navigated patients. We used logistic regression to report the demographic and healthcare utilization characteristics associated with patients allocated to PN who were successfully reached. We identified 1,200 patients with an abnormal fecal immunochemical test result, of whom 970 were randomized into the study (45.7% were female, 17.5% were Spanish-speaking, and the mean age was 60.8 years). Of the 479 patients allocated to the PN intervention, 382 (79.7%) were reached within 18 call attempts, and nearly all (n = 356; 93.2%) were reached within six contact attempts. Patient characteristics associated with reach were race, county of residence, and body mass index. Our findings can guide future efforts to optimize the reach of PN programs. Prevention Relevance: The findings from this large study can inform clinic-level implementation of future PN programs in Federally Qualified Health Centers to improve the reach of patients needing cancer screenings, optimize staff resources, and ultimately increase cancer screenings.
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Affiliation(s)
- Priyanka Gautom
- Kaiser Permanente Center for Health Research 3800 N. Interstate Ave. Portland, OR 97227
- OHSU-PSU School of Public Health 1810 SW 5th Ave Portland, OR 97201
| | - Ana Gabriela Rosales
- Kaiser Permanente Center for Health Research 3800 N. Interstate Ave. Portland, OR 97227
| | - Amanda F. Petrik
- Kaiser Permanente Center for Health Research 3800 N. Interstate Ave. Portland, OR 97227
| | - Jamie H. Thompson
- Kaiser Permanente Center for Health Research 3800 N. Interstate Ave. Portland, OR 97227
| | - Matthew T. Slaughter
- Kaiser Permanente Center for Health Research 3800 N. Interstate Ave. Portland, OR 97227
| | - Leslie Mosso
- Sea Mar Community Health Centers 1040 S. Henderson St. Seattle, WA 98108
| | - Syed Akmal Hussain
- Sea Mar Community Health Centers 1040 S. Henderson St. Seattle, WA 98108
| | - Ricardo Jimenez
- Sea Mar Community Health Centers 1040 S. Henderson St. Seattle, WA 98108
| | - Gloria D. Coronado
- Kaiser Permanente Center for Health Research 3800 N. Interstate Ave. Portland, OR 97227
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Lee H, Baeker Bispo J, Pal Choudhury P, Wiese D, Jemal A, Islami F. Factors contributing to differences in cervical cancer screening in rural and urban community health centers. Cancer 2024; 130:2315-2324. [PMID: 38523461 DOI: 10.1002/cncr.35265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Community health centers (CHCs) provide historically marginalized populations with primary care, including cancer screening. Previous studies have reported that women living in rural areas are less likely to be up to date with cervical cancer screening than women living in urban areas. However, little is known about rural-urban differences in cervical cancer screening in CHCs and the contributing factors, and whether such differences changed during the COVID-19 pandemic. METHODS Using 8-year pooled Uniform Data System (2014-2021) data and Oaxaca-Blinder decomposition, the extent to which CHC- and catchment area-level characteristics explained rural-urban differences in up-to-date cervical cancer screening was estimated. RESULTS Up-to-date cervical cancer screening was lower in rural CHCs than urban CHCs (38.2% vs 43.0% during 2014-2019), and this difference increased during the pandemic (43.5% vs 49.0%). The rural-urban difference in cervical cancer screening in 2014-2019 was mostly explained by differences in CHC-level proportions of patients with limited English proficiency (55.9%) or income below the poverty level (12.3%) and females aged 21 to 64 years (9.8%), and catchment area-level's unemployment (3.4%) and primary care physician density (3.2%). However, Medicaid (-48.5%) or no insurance (-19.6%) counterbalanced the differences between rural-urban CHCs. The contribution of these factors to rural-urban differences in cervical cancer screening generally increased in 2020-2021. CONCLUSIONS Rural-urban differences in cervical cancer screening were mostly explained by multiple CHC-level and catchment area-level characteristics. The findings call for tailored interventions, such as providing resources and language services, to improve cancer screening utilization among uninsured, Medicaid, and patients with limited English proficiency in rural CHCs.
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Affiliation(s)
- Hyunjung Lee
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Jordan Baeker Bispo
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Parichoy Pal Choudhury
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Daniel Wiese
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Farhad Islami
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
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Molina Y, Tsai E, Enqubahry Y, Lee E, Siddiqi F, Gottesman A, Boylan E, Paz K, Wright ME, Abrol E, Lofton S, Kim SJ, Patel A. Equity in Cancer and Chronic Disease Prevention through a Multi-Pronged Network Intervention: Works-in-Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:213. [PMID: 38397702 PMCID: PMC10888495 DOI: 10.3390/ijerph21020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified health centers) to reduce the risks of cancer, chronic disease, and other conditions. In this study, we tested whether improving personal health literacy (i.e., confidence in seeking information) and enabling successful information transfer (i.e., intention to share the specific information learned through the program) among community residents could contribute to greater diffusion intention (i.e., number of network members with whom residents plan to share information and resources). The current study used post-intervention surveys, which were administered to Chicago residents who were 18 years or older and had participated in the program. Among the 1499 diverse Chicago residents, improved personal health literacy was associated with greater diffusion intention (ORs = 2.00-2.68, 95% CI [1.27-4.39], p ≤ 0.003). Successful information transfer was associated with greater diffusion, especially for cancer and other chronic disease risk reductions (ORs = 3.43-3.73, 95% CI [1.95-6.68], p < 0.001). The findings highlight the potential gains for health equity through sustainable, scalable, multi-sectoral partnerships.
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Affiliation(s)
- Yamilé Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Edward Tsai
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Yalemzewod Enqubahry
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Eunhye Lee
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Faria Siddiqi
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Anna Gottesman
- School of Public Health, George Washington Milkin Institute, Washington, DC 20037, USA;
| | - Emma Boylan
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
| | - Kate Paz
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
| | - Margaret E. Wright
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Ekas Abrol
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Saria Lofton
- Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Sage J. Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Ajanta Patel
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
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Aschbrenner KA, Cruz JL, Kruse GR, Nguyen H, Huebner Torres C, Celli M, Sarcione C, Singh D, Emmons KM. Leveraging an implementation science partnership network to understand how Federally Qualified Health Centers operationalize and address health equity. Transl Behav Med 2024; 14:23-33. [PMID: 37542519 PMCID: PMC10782902 DOI: 10.1093/tbm/ibad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
Health equity-focused implementation research requires using definitions and approaches that are relevant and meaningful to implementation partners. We examined how health equity was operationalized and addressed at Federally Qualified Health Centers (FQHCs). We conducted semi-structured interviews with leadership (n = 19) and staff (n = 12) at 10 FQHCs in an implementation science partnership network for cancer control equity to understand how they operationalized and addressed health equity. We performed rapid qualitative analysis and shared findings with a larger group of 13 community health centers (including the 10 FQHCs) at an Implementation Learning Community (ILC) to identify action areas for research and practice, followed by a second phase of synthesizing qualitative codes into themes and mapping themes onto a framework for advancing health equity in healthcare organizations. Participants defined health equity as central to the mission of FQHCs, and identified barriers (e.g. financing models) and facilitators (e.g. interpreter services) to advancing health equity at FQHCs. These findings resonated with ILC participants who emphasized the challenge of addressing root cause social determinants of inequities using limited available resources in FQHCs and the importance of developing meaningful collaboration with communities for data collection, data interpretation, data use, and data ownership. Themes captured recommendations to advance health equity in daily work at FQHCs, including investments in staffing, training, and resources. Mapping qualitative themes from health equity-centered interviews with FQHC partners onto a framework for advancing health equity in healthcare organizations can provide clear, context-specific direction for actions aimed at improving health and healthcare equity.
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Affiliation(s)
- Kelly A Aschbrenner
- Geisel School of Medicine at Dartmouth College, Hanover, USA
- Dartmouth Health System, Lebanon, USA
| | | | | | | | | | - Maria Celli
- Brockton Neighborhood Health Center, Brockton, MA, USA
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Luque JS, Kiros GE, Vargas M, Jackson DR, Matthew OO, Austin TD, Tawk R, Ali AA, Harris CM, Wallace K, Gwede CK. Association of Preventive Care Attitudes and Beliefs with Colorectal Cancer Screening History among African American Patients of Community Health Centers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1816-1824. [PMID: 37442915 PMCID: PMC10787027 DOI: 10.1007/s13187-023-02337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer-related death among African Americans in the United States. However, when detected early, CRC is treatable and survival rates are high. CRC health disparities for African Americans compared with other groups may be due in part to lower screening adherence and later stage diagnosis. The objective of this research phase was to test predictors of ever having received CRC screening (i.e., self-report of lifetime receipt of CRC screening) using survey measures in the domains of healthcare communication, trust in doctors, CRC perceived susceptibility, CRC worry, negative cancer beliefs, CRC screening self-efficacy, and cultural constructs for CRC screening in a sample of African American community health center patients. The study recruited 115 African American patients between the ages of 45 to 64 years old from community health centers in north Florida to complete the baseline survey. Our results show significant differences in CRC screening history by age, marital status, level of mistrust of healthcare providers, and level of empowerment toward cancer screening. To increase CRC screening in this population, the study findings suggest development of intervention programs that focus on priority populations of younger, unmarried African Americans, especially given the current trend of early onset CRC. Moreover, survival rates are lower for unmarried and younger African Americans relative to older and married individuals. Such interventions should also aim to increase trust in healthcare providers and increase empowerment for CRC screening decision making to increase screening participation.
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Affiliation(s)
- John S Luque
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA.
| | - Gebre-Egziabher Kiros
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Matthew Vargas
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Deloria R Jackson
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Olayemi O Matthew
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Tifini D Austin
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Rima Tawk
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Askal A Ali
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Cynthia M Harris
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Clement K Gwede
- Division of Population Sciences, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, 33612, USA
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Ceccarelli A, Minotti A, Senni M, Pellegrini L, Benati G, Ceccarelli P, Federici A, Mazzini S, Reali C, Sintoni F, Gori D, Montalti M. Healthcare Service Quality Evaluation in a Community-Oriented Primary Care Center, Italy. Healthcare (Basel) 2023; 11:2396. [PMID: 37685430 PMCID: PMC10486978 DOI: 10.3390/healthcare11172396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/12/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Community-oriented primary care (COPC) is an inclusive healthcare approach that combines individual care with a population-based outlook, striving to offer effective and equitable services. This study concentrates on assessing the perceived quality of a "Casa della Comunità" (CdC) implemented by the Romagna Local Health Authority, which embraces the COPC model. Through the examination of user experiences, the study aims to comprehend the influence of the CdC's care delivery model on the community's perception of service quality. From 13-18 March 2023, paper questionnaires were distributed by trained healthcare professionals and volunteers. The cross-sectional study enrolled participants aged 18 or older, capable of understanding written Italian, and willing to take part voluntarily. A total of 741 questionnaires were collected, resulting in an overall acceptance rate of 85.6%. Among the respondents, 37.9% were female, with an average age of 55.4 ± 16.2 years. While the respondents generally held a positive view of the quality, the results displayed varying levels of satisfaction across the different areas. Multivariate analysis revealed significant associations between factors such as gender, employment status, financial resources, education level, and distance from the healthcare center with the perceived quality of the facility in terms of accessibility, environment, staff, continuity of care, and overall satisfaction. The study yielded valuable insights, identifying strengths and areas for improvement and underscoring the importance of ongoing monitoring studies to enhance patient satisfaction continuously.
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Affiliation(s)
- Andrea Ceccarelli
- Operative Unit of Hygiene and Public Health of Forlì-Cesena, Department of Public Health, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Alice Minotti
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Marco Senni
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Luca Pellegrini
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Giuseppe Benati
- Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47121 Forlì, Italy
| | - Paola Ceccarelli
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Andrea Federici
- Operative Unit of Hygiene and Public Health of Forlì-Cesena, Department of Public Health, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Silvia Mazzini
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47121 Forlì, Italy
| | - Chiara Reali
- Operative Unit of Hygiene and Public Health of Forlì-Cesena, Department of Public Health, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Francesco Sintoni
- Rubicone Health District, Romagna Local Health Authority, 47522 Cesena, Italy
| | - Davide Gori
- Hygiene Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Marco Montalti
- Operative Unit of Hygiene and Public Health of Forlì-Cesena, Department of Public Health, Romagna Local Health Authority, 47521 Cesena, Italy
- Hygiene Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
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Huguet N, Danna M, Baron A, Hall J, Hodes T, O’Malley J, Holderness H, Marino M, DeVoe JE, Cohen DJ. Delivery of Cervical and Colorectal Cancer Screenings During the Pandemic in Community Health Centers: Practice Changes and Recovery Strategies. Med Care 2023; 61:554-561. [PMID: 37310241 PMCID: PMC10319245 DOI: 10.1097/mlr.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic led to clinical practice changes, which affected cancer preventive care delivery. OBJECTIVES To investigate the impact of the coronavirus disease 2019 pandemic on the delivery of colorectal cancer (CRC) and cervical cancer (CVC) screenings. RESEARCH DESIGN Parallel mixed methods design using electronic health record data (extracted between January 2019 and July 2021). Study results focused on 3 pandemic-related periods: March-May 2020, June-October 2020, and November 2020-September 2021. SUBJECTS Two hundred seventeen community health centers located in 13 states and 29 semistructured interviews from 13 community health centers. MEASURES Monthly up-to-date CRC and CVC screening rates and monthly rates of completed colonoscopies, fecal immunochemical test (FIT)/fecal occult blood test (FOBT) procedures, Papanicolaou tests among age and sex-eligible patients. Analysis used generalized estimating equations Poisson modeling. Qualitative analysts developed case summaries and created a cross-case data display for comparison. RESULTS The results showed a reduction of 75% for colonoscopy [rate ratio (RR) = 0.250, 95% CI: 0.224-0.279], 78% for FIT/FOBT (RR = 0.218, 95% CI: 0.208-0.230), and 87% for Papanicolaou (RR = 0.130, 95% CI: 0.125-0.136) rates after the start of the pandemic. During this early pandemic period, CRC screening was impacted by hospitals halting services. Clinic staff moved toward FIT/FOBT screenings. CVC screening was impacted by guidelines encouraging pausing CVC screening, patient reluctance, and concerns about exposure. During the recovery period, leadership-driven preventive care prioritization and quality improvement capacity influenced CRC and CVC screening maintenance and recovery. CONCLUSIONS Efforts supporting quality improvement capacity could be key actionable elements for these health centers to endure major disruptions to their care delivery system and to drive rapid recovery.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Maria Danna
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Andrea Baron
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Jennifer Hall
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Tahlia Hodes
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | | | - Heather Holderness
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Deborah J. Cohen
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
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Huguet N, Ezekiel-Herrera D, Gunn R, Pierce A, O'Malley J, Jones M, Marino M, Gold R. Uptake of a Cervical Cancer Clinical Decision Support Tool: A Mixed-Methods Study. Appl Clin Inform 2023; 14:594-599. [PMID: 37532232 PMCID: PMC10411153 DOI: 10.1055/s-0043-1769913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/26/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES Clinical decision support (CDS) tools that provide point-of-care reminders of patients' care needs may improve rates of guideline-concordant cervical cancer screening. However, uptake of such electronic health record (EHR)-based tools in primary care practices is often low. This study describes the frequency of factors associated with, and barriers and facilitators to adoption of a cervical cancer screening CDS tool (CC-tool) implemented in a network of community health centers. METHODS This mixed-methods sequential explanatory study reports on CC-tool use among 480 community-based clinics, located across 18 states. Adoption of the CC-tool was measured as any instance of tool use (i.e., entry of cervical cancer screening results or follow-up plan) and as monthly tool use rates from November 1, 2018 (tool release date) to December 31, 2020. Adjusted odds and rates of tool use were evaluated using logistic and negative-binomial regression. Feedback from nine clinic staff representing six clinics during user-centered design sessions and semi-structured interviews with eight clinic staff from two additional clinics were conducted to assess barriers and facilitators to tool adoption. RESULTS The CC-tool was used ≥1 time in 41% of study clinics during the analysis period. Clinics that ever used the tool and those with greater monthly tool use had, on average, more encounters, more patients from households at >138% federal poverty level, fewer pediatric encounters, higher up-to-date cervical cancer screening rates, and higher rates of abnormal cervical cancer screening results. Qualitative data indicated barriers to tool adoption, including lack of knowledge of the tool's existence, understanding of its functionalities, and training on its use. CONCLUSION Without effective systems for informing users about new EHR functions, new or updated EHR tools are unlikely to be widely adopted, reducing their potential to improve health care quality and outcomes.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - David Ezekiel-Herrera
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Rose Gunn
- OCHIN Inc., Portland, Oregon, United States
| | | | | | | | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Rachel Gold
- OCHIN Inc., Portland, Oregon, United States
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, United States
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10
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The First Year of the COVID-19 Pandemic: Changes in Preventive Services in Community Health Centers. Am J Prev Med 2023; 64:184-193. [PMID: 36273931 PMCID: PMC9584826 DOI: 10.1016/j.amepre.2022.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Community Health Centers provide comprehensive primary healthcare services to many underserved populations. It is unknown how routine preventive and chronic care services in Community Health Centers may have changed nationwide during the COVID-19 pandemic. METHODS The 2014-2020 Health Resources and Services Administration Uniform Data System of Community Health Centers was used, and data analysis was conducted from November 2021 to May 2022. Data for clinical quality measures in 2020 were treated as during the pandemic, whereas receipt of care in 2019 and before were treated as before the pandemic. Outcomes included 6 clinical quality measures of being up to date for colorectal cancer screening, cervical cancer screening, tobacco screening and cessation counseling, BMI screening and follow-up, depression screening and follow-up, and aspirin use for ischemic vascular disease. A mixed effects regression model was used to estimate changes in measures by year. RESULTS Between 2019 and 2020, receipt of preventive services declined for each of the 6 clinical quality measures: from 40.8% to 37.7% for colorectal cancer screening, from 48.8% to 44.9% for cervical cancer screening, from 85.8% to 83.4% for tobacco screening and cessation counseling, from 70.7% to 65.4% for BMI screening and follow-up, from 71.1% to 64.9% for depression screening and follow-up, and from 81.5% to 79.4% for aspirin use for ischemic vascular disease. CONCLUSIONS Receipt of preventive services in Community Health Centers declined during the COVID-19 pandemic for each of the 6 clinical quality measures considered in the study. Immediate action is required to support ongoing high-quality, primary healthcare services in Community Health Centers across the nation.
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11
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Bonuck KJ, Angier H, McCrimmon S, Holderness H, Erroba J, Huguet N, DeVoe JE, Carney PA. A Scoping Literature Review on Evidence-Based Strategies to Increase Cervical Cancer Screening. J Prim Care Community Health 2023; 14:21501319231220994. [PMID: 38131106 DOI: 10.1177/21501319231220994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Previous reviews of strategies to increase cervical cancer screening are more than 10 years old, the U.S. continues to fall short of the Healthy People 2030 cervical cancer screening goal, and guidelines were revised in 2018, therefore an updated review of the existing literature is needed. We conducted a scoping review using electronic databases PubMed, Scopus, and Ovid Medline that included publication dates between 2012 and 2021 to answer the question, "Which strategies implemented in U.S. primary care settings have been most successful in increasing rates of cervical cancer screening since the 2012 US Preventative Services Task Force cervical cancer screening guidelines were published?" We mapped findings to pre-specified implementation strategy categories. After initially identifying 399 articles, we excluded 350 due to duplicates or not meeting review criteria, leaving 49 articles for full review. We excluded 37 of these during full-text review and identified 2 additional articles from the manual search of reference lists for a total of 14 studies for abstraction. Eleven articles reported on strategies resulting in increased cervical cancer screening, and 3 did not. Clinic workflow re-design strategies showed the greatest promise in improving cervical cancer screening rates, education strategies for patients had mixed results, and quality management strategies were not effective. These findings suggest clinical workflow re-structures and patient education strategies can increase cervical cancer screening in primary care settings. Results are particularly important in settings that care for underserved populations, as these settings may need additional implementation strategies to decrease cervical cancer screening disparities.
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Affiliation(s)
| | | | | | | | - Jeremy Erroba
- Oregon Health & Science University, Portland, OR, USA
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12
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Dee EC, Pierce LJ, Winkfield KM, Lam MB. In pursuit of equity in cancer care: moving beyond the Affordable Care Act. Cancer 2022; 128:3278-3283. [PMID: 35818772 DOI: 10.1002/cncr.34346] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022]
Abstract
Although Medicaid Expansion under the Patient Protection and Affordable Care Act (ACA) has been associated with many improvements for patients with cancer, Snyder et al. provide evidence demonstrating the persistence of racial disparities in cancer. This Editorial describes why insurance coverage alone does not ensure access to health care, highlights various manifestations of structural racism that constitute barriers to access beyond the direct costs of care, and calls for not just equality, but equity, in cancer care.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lori J Pierce
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
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13
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Christy SM, Sutton SK, Abdulla R, Boxtha C, Gonzalez P, Cousin L, Ewing A, Montoya S, Lopez D, Beehler T, Sanchez J, Carvajal R, Meade CD, Gwede CK. A multilevel, low literacy dual language intervention to promote colorectal cancer screening in community clinics in Florida: A randomized controlled trial. Prev Med 2022; 158:107021. [PMID: 35305995 PMCID: PMC9018599 DOI: 10.1016/j.ypmed.2022.107021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/28/2022] [Accepted: 03/13/2022] [Indexed: 01/27/2023]
Abstract
One of the largest disparities in cancer mortality in the United States occurs with colorectal cancer (CRC). The objectives of this multilevel two-arm intervention trial were to compare the efficacy of two interventions to promote CRC screening (CRCS) with fecal immunochemical test (FIT) and examine sociodemographic and psychosocial predictors of FIT screening. Individuals ages 50-75 (n = 326) who were not up-to-date with CRCS, could understand English or Spanish, and were at average CRC risk were recruited from two federally qualified health centers (FQHCs) in Florida. Prior to intervention, CRCS rates in the FQHCs were 27.1% and 32.9%, respectively. Study enrollment occurred April 2018-November 2019. System-level intervention components included leveraging electronic medical record (EMR) systems and delivering patient reminders. Participants were randomized to C-CARES (education+FIT) or C-CARES Plus (C-CARES+personalized coaching [for those not completing FIT within 90 days]). Primary outcome was completed FIT returned <1 year. Primary outcome analyses were performed using logistic regression. 225 participants completed FIT (69.0% [95% CI: 64.0-74.0%]), with no significant difference in FIT uptake by intervention arm (67.3% C-CARES Plus vs. 70.8% C-CARES; p = .49). FIT uptake was significantly higher among patients who received intervention materials in Spanish (77.2%) compared to those who received materials in English (63.2%, p < .01). The personalized coaching in the C-CARES Plus arm did not appear to provide added benefit beyond the C-CARES intervention. Multilevel approaches that include EMR prompts, reminders, FIT access, and provision of low-literacy, language-concordant education can support efforts to improved community clinics' CRCS rates. Future efforts should focus on repeat FIT screening. Trial registration: The trial was registered at ClinicalTrials.gov (NCT03906110).
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Affiliation(s)
- Shannon M Christy
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America.
| | - Steven K Sutton
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Rania Abdulla
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Carol Boxtha
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Paola Gonzalez
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Lakeshia Cousin
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; University of Florida, Gainesville, Florida, United States of America
| | - Aldenise Ewing
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Ohio State University, Columbus, Ohio, United States of America
| | - Samantha Montoya
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Diana Lopez
- Suncoast Community Health Centers, Inc., Brandon, Florida, United States of America
| | - Tina Beehler
- Premier Community HealthCare Group, Inc., Dade City, Florida, United States of America
| | - Julian Sanchez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Rodrigo Carvajal
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Cathy D Meade
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Clement K Gwede
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
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14
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Bailey SR, Voss R, Angier H, Huguet N, Marino M, Valenzuela SH, Chung-Bridges K, DeVoe JE. Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: an observational cohort study. BMC Health Serv Res 2022; 22:488. [PMID: 35414079 PMCID: PMC9004133 DOI: 10.1186/s12913-022-07860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background Smoking among cancer survivors can increase the risk of cancer reoccurrence, reduce treatment effectiveness and decrease quality of life. Cancer survivors without health insurance have higher rates of smoking and decreased probability of quitting smoking than cancer survivors with health insurance. This study examines the associations of the Affordable Care Act (ACA) Medicaid insurance expansion with smoking cessation assistance and quitting smoking among cancer survivors seen in community health centers (CHCs). Methods Using electronic health record data from 337 primary care community health centers in 12 states that expanded Medicaid eligibility and 273 CHCs in 8 states that did not expand, we identified adult cancer survivors with a smoking status indicating current smoking within 6 months prior to ACA expansion in 2014 and ≥ 1 visit with smoking status assessed within 24-months post-expansion. Using an observational cohort propensity score weighted approach and logistic generalized estimating equation regression, we compared odds of quitting smoking, having a cessation medication ordered, and having ≥6 visits within the post-expansion period among cancer survivors in Medicaid expansion versus non-expansion states. Results Cancer survivors in expansion states had higher odds of having a smoking cessation medication order (adjusted odds ratio [aOR] = 2.54, 95%CI = 1.61-4.03) and higher odds of having ≥6 office visits than those in non-expansion states (aOR = 1.82, 95%CI = 1.22-2.73). Odds of quitting smoking did not differ significantly between patients in Medicaid expansion versus non-expansion states. Conclusions The increased odds of having a smoking cessation medication order among cancer survivors seen in Medicaid expansion states compared with those seen in non-expansion states provides evidence of the importance of health insurance coverage in accessing evidence-based tobacco treatment within CHCs. Continued research is needed to understand why, despite increased odds of having a cessation medication prescribed, odds of quitting smoking were not significantly higher among cancer survivors in Medicaid expansion states compared to non-expansion states.
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Affiliation(s)
- Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
| | - Robert Voss
- OCHIN, Inc, 1881 SW Naito Parkway, Portland, OR, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,Division of Biostatistics, School of Public Health, Oregon Health & Science University - Portland State University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Steele H Valenzuela
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | | | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
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