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Aschbrenner KA, Haines ER, Kruse GR, Olugbenga AO, Thomas AN, Khan T, Martinez S, Emmons KM, Bartels SJ. Applying cognitive walkthrough methodology to improve the usability of an equity-focused implementation strategy. Implement Sci Commun 2024; 5:95. [PMID: 39227912 PMCID: PMC11373107 DOI: 10.1186/s43058-024-00630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/18/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Our research team partnered with primary care and quality improvement staff in Federally Qualified Community Health Centers (CHCs) to develop Partnered and Equity Data-Driven Implementation (PEDDI) to promote equitable implementation of evidence-based interventions. The current study used a human-centered design methodology to evaluate the usability of PEDDI and generate redesign solutions to address usability issues in the context of a cancer screening intervention. METHODS We applied the Cognitive Walkthrough for Implementation Strategies (CWIS), a pragmatic assessment method with steps that include group testing with end users to identify and prioritize usability problems. We conducted three facilitated 60-min CWIS sessions with end users (N = 7) from four CHCs that included scenarios and related tasks for implementing a colorectal cancer (CRC) screening intervention. Participants rated the likelihood of completing each task and identified usability issues and generated ideas for redesign solutions during audio-recorded CWIS sessions. Participants completed a pre-post survey of PEDDI usability. Our research team used consensus coding to synthesize usability problems and redesign solutions from transcribed CWIS sessions. RESULTS Usability ratings (scale 0-100: higher scores indicating higher usability) of PEDDI averaged 66.3 (SD = 12.4) prior to the CWIS sessions. Scores averaged 77.8 (SD = 9.1) following the three CWIS sessions improving usability ratings from "marginal acceptability" to "acceptable". Ten usability problems were identified across four PEDDI tasks, comprised of 2-3 types of usability problems per task. CWIS participants suggested redesign solutions that included making data fields for social determinants of health and key background variables for identifying health equity targets mandatory in the electronic health record and using asynchronous communication tools to elicit ideas from staff for adaptations. CONCLUSIONS Usability ratings indicated PEDDI was in the acceptable range following CWIS sessions. Staff identified usability problems and redesign solutions that provide direction for future improvements in PEDDI. In addition, this study highlights opportunities to use the CWIS methodology to address inequities in the implementation of cancer screening and other clinical innovations in resource-constrained healthcare settings.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
- Dartmouth Health Merrimack Family Practice, 294 Daniel Webster Highway, Merrimack, NH, 03054, USA.
| | - Emily R Haines
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC, 27101, USA
| | - Gina R Kruse
- Division of General Internal Medicine, University of Colorado School of Medicine, 13001 E 17th PL, Aurora, CO, 80045, USA
| | - Ayotola O Olugbenga
- Brockton Neighborhood Health Center, 63 Main Street, Brockton, MA, 02301, USA
| | - Annette N Thomas
- Brockton Neighborhood Health Center, 63 Main Street, Brockton, MA, 02301, USA
| | - Tanveer Khan
- Harvard Street Neighborhood Health Center, 632 Blue Hill Ave, Dorchester, MA, 02121, USA
| | | | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Stephen J Bartels
- Massachusetts General Hospital, 125 Nashua St, Boston, MA, 02114, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- The Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street Suite 1600, Boston, MA, 02114, USA
- Harvard Medical School, 25 ShaAuck Street, Boston, MA, 02115, USA
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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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Glaser KM, Crabtree-Ide CR, McNulty AD, Attwood KM, Flores TF, Krolikowski AM, Robillard KT, Reid ME. Improving Guideline-Recommended Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC): Implementing a Patient Navigation and Practice Facilitation Intervention to Promote Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:126. [PMID: 38397617 PMCID: PMC10887785 DOI: 10.3390/ijerph21020126] [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: 11/27/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is effective in the prevention and early detection of cancer. Implementing evidence-based screening guidelines remains a challenge, especially in Federally Qualified Health Centers (FQHCs), where current rates (43%) are lower than national goals (80%), and even lower in populations with limited English proficiency (LEP) who experience increased barriers to care related to systemic inequities. METHODS This quality improvement (QI) initiative began in 2016, focused on utilizing patient navigation and practice facilitation to addressing systemic inequities and barriers to care to increase CRC screening rates at an urban FQHC, with two clinical locations (the intervention and control sites) serving a diverse population through culturally tailored education and navigation. RESULTS Between August 2016 and December 2018, CRC screening rates increased significantly from 31% to 59% at the intervention site (p < 0.001), with the most notable change in patients with LEP. Since 2018 through December 2022, navigation and practice facilitation expanded to all clinics, and the overall CRC screening rates continued to increase from 43% to 50%, demonstrating the effectiveness of patient navigation to address systemic inequities. CONCLUSIONS This multilevel intervention addressed structural inequities and barriers to care by implementing evidence-based guidelines into practice, and combining patient navigation and practice facilitation to successfully increase the CRC screening rates at this FQHC.
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Affiliation(s)
- Kathryn M. Glaser
- Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Christina R. Crabtree-Ide
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
| | - Alyssa D. McNulty
- Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Kristopher M. Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Tessa F. Flores
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
| | | | - Kevin T. Robillard
- Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Mary E. Reid
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
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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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Barrera Ferro D, Bayer S, Bocanegra L, Brailsford S, Díaz A, Gutiérrez-Gutiérrez EV, Smith H. Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach. PLoS One 2022; 17:e0271874. [PMID: 35867727 PMCID: PMC9307170 DOI: 10.1371/journal.pone.0271874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
The global burden of cervical cancer remains a concern and higher early mortality rates are associated with poverty and limited health education. However, screening programs continue to face implementation challenges, especially in developing country contexts. In this study, we use a mixed-methods approach to understand the reasons for no-show behaviour for cervical cancer screening appointments among hard-to-reach low-income women in Bogotá, Colombia. In the quantitative phase, individual attendance probabilities are predicted using administrative records from an outreach program (N = 23384) using both LASSO regression and Random Forest methods. In the qualitative phase, semi-structured interviews are analysed to understand patient perspectives (N = 60). Both inductive and deductive coding are used to identify first-order categories and content analysis is facilitated using the Framework method. Quantitative analysis shows that younger patients and those living in zones of poverty are more likely to miss their appointments. Likewise, appointments scheduled on Saturdays, during the school vacation periods or with lead times longer than 10 days have higher no-show risk. Qualitative data shows that patients find it hard to navigate the service delivery process, face barriers accessing the health system and hold negative beliefs about cervical cytology.
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Affiliation(s)
- David Barrera Ferro
- Southampton Business School, University of Southampton, Southampton, United Kingdom
- Departamento de Ingeniería Industrial, Pontificia Universidad Javeriana, Bogotá, Colombia
- * E-mail:
| | - Steffen Bayer
- Southampton Business School, University of Southampton, Southampton, United Kingdom
| | | | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, United Kingdom
| | - Adriana Díaz
- Departamento de Ingeniería Industrial, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Honora Smith
- Mathematical Sciences, University of Southampton, Southampton, United Kingdom
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Syed Soffian SS, Mohammed Nawi A, Hod R, Abdul Manaf MR, Chan HK, Abu Hassan MR. Disparities in Recommendations for Colorectal Cancer Screening Among Average-Risk Individuals: An Ecobiosocial Approach. Risk Manag Healthc Policy 2022; 15:1025-1043. [PMID: 35599752 PMCID: PMC9115807 DOI: 10.2147/rmhp.s359450] [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: 02/09/2022] [Accepted: 05/01/2022] [Indexed: 12/09/2022] Open
Abstract
Regardless of the high global burden of colorectal cancer (CRC), the uptake of CRC screening varies across countries. This systematic review aimed to provide a picture of the disparities in recommendations for CRC screening in average-risk individuals using an ecobiosocial approach. It was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was conducted through Scopus, Web of Science, PubMed, and EBSCOHost. Full-text guidelines which were published between 2011 and 2021, along with guidelines which provided recommendations on CRC screening in average-risk individuals, were included in the review. However, guidelines focusing only on a single screening modality were excluded. Fourteen guidelines fulfilling the eligibility criteria were retained for the final review and analysis. Quality assessment of each guideline was performed using the AGREE II instrument. Disparities in guidelines identified in this review were classified into ecological (screening modalities and strategies), biological (recommended age, gender and ethnicities), and social (smoking history, socioeconomic status, and behavior) factors. In general, unstandardized practices in CRC screening for average-risk individuals are likely attributable to the inconsistent and non-specific recommendations in the literature. This review calls on stakeholders and policymakers to review the existing colorectal cancer screening practices and pursue standardization.
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Affiliation(s)
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Huan-Keat Chan
- Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, 05400, Kedah, Malaysia
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Zoellner JM, Porter KJ, Thatcher E, Allanson D, Brauns M. Improving Fecal Immunochemical Test Return Rates: A Colorectal Cancer Screening Quality Improvement Project in a Multisite Federally Qualified Health Center. Health Promot Pract 2022:15248399221083294. [PMID: 35382617 DOI: 10.1177/15248399221083294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this quality improvement project was to improve colorectal cancer (CRC) screening rates in a multicenter federally qualified health center (FQHC) within the Central Appalachian region of rural, southwestern Virginia. Guided by the Plan-Do-Study-Act (PDSA) cycle, the objectives were to (1) evaluate implementation processes and effectiveness of an automated electronic medical record patient reminder system to promote fecal immunochemical test (FIT) completion, compared with live telephone reminders delivered by a care coordinator (i.e., usual care), and (2) explore staff perceptions related to improving CRC screening rates. In total, 119 FITs were distributed with 59 assigned to usual care and 60 to the automated groups. In the usual care group, 79% patients with completed protocol returned their FIT; 9% were positive. In the automated reminder group, 76% patients with completed protocol returned their FIT; 10% were positive. There was no significant difference in the number of contacts per patients between the usual care (2.0, SD = 0.82 contacts/patient) and automated (1.8, SD = 0.98 contacts/patient) groups (p = .248). In total, the usual care and automated groups required 56 and 17 live calls, respectively. Overall, FQHC system-wide CRC screening rates increase from 30.5% to 47.3%. Ten staff interviews revealed perceptions of CRC screening, the QI project, and organizational change processes that may inform future cancer control projects. Researcher and practitioners should consider PDSA quality improvement projects as an initial step to build capacity and improve CRC screening rates, especially when working in FQHC with limited resources to engage in large complex research projects.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | - Dylan Allanson
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Michelle Brauns
- Community Health Center of the New River Valley, Christiansburg, VA, USA
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Huguet N, Hodes T, Holderness H, Bailey SR, DeVoe JE, Marino M. Community Health Centers' Performance in Cancer Screening and Prevention. Am J Prev Med 2022; 62:e97-e106. [PMID: 34663549 PMCID: PMC8748316 DOI: 10.1016/j.amepre.2021.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Little is known about what clinic-level factors differentiate community health centers that achieve high performance on cancer-preventive care metrics. This study aims to describe the longitudinal trends in the delivery of 3 cancer-preventive care metrics (cervical and colorectal cancer screenings and tobacco-cessation intervention) and define and compare community health centers with high cancer-preventive care performance with those with low cancer-preventive care performance. METHODS This observational study used 2012-2019 community health center data (N=933) from the Uniform Data System. High/low performance was based on Healthy People 2020 targets and sample distribution. For each cancer-preventive care metric, the percentage of community health centers that met high (≥70.5% at cervical or colorectal cancer screening or >80% tobacco-cessation intervention) and low thresholds at 1, 2, and all the 3 screenings was estimated. Multivariable generalized estimating equations logistic regression modeling was used to assess the community health center‒level factors associated with screening performance. RESULTS The community health centers' performance for tobacco-cessation intervention remained at ≥80%, with a small increase over time. Performance for cervical cancer screening remained unchanged with about 50% of patients screened. Colorectal cancer screening performance increased from around 30% in 2012 to 44% in 2019. Very few community health centers reached high performance (3%) in all the 3 indicators, and 13% of community health centers were high in any 2 of the outcomes in 2019. Higher patient volume, a greater proportion of Hispanic patients, fewer uninsured patients, and community health centers located in the Northeast region were associated with high performance in 2019. CONCLUSIONS Very few community health centers meet all Healthy People 2020 goals in cancer screenings and may struggle to achieve the 2030 goals. Very few indicators differentiated high performers from low performers.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tahlia Hodes
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Heather Holderness
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; Biostatistics Group, School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
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Insurance-Mediated Disparities in Gynecologic Oncology Care. Obstet Gynecol 2022; 139:305-312. [PMID: 34991133 PMCID: PMC8759538 DOI: 10.1097/aog.0000000000004643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022]
Abstract
Insurance coverage has lagged behind improvements in gynecologic cancer care, with one third of women never seeing a gynecologic oncologist and half experiencing financial toxicity during cancer treatment. With 102,000 new cases of gynecologic cancer, 30,000 associated deaths annually, and increasing rates of endometrial cancer, gynecologic cancer is a growing problem. Although gynecologic cancer care has advanced significantly in the past decade owing to new therapeutics and specialized training in radical surgery, even insured women face major barriers to accessing and affording quality gynecologic cancer care. This commentary reviews current literature on insurance-mediated disparities in gynecologic cancer and provides education to clinicians on barriers to care. One third of women with a gynecologic cancer never see a gynecologic oncologist. Up to 40% of Medicare Advantage plans lack an in-network gynecologic oncologist, and 33% of private insurance plans do not include an in-network National Cancer Institute-accredited cancer center, limiting access to surgical advances and clinical trials. Women with Medicaid insurance and gynecologic cancer are 25% less likely to receive guideline-concordant care. Among insured women, 50% experience financial toxicity during gynecologic cancer treatment, and costs may be even higher for certain Medicare enrollees. Addressing these insurance-mediated disparities will be important to help our patients fully benefit from the scientific advances in our field and thrive after a gynecologic cancer diagnosis.
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Topmiller M, McCann J, Rankin J, Hoang H, Bolton J, Sripipatana A. Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres. Fam Med Community Health 2021; 9:fmch-2020-000853. [PMID: 34215670 PMCID: PMC8256755 DOI: 10.1136/fmch-2020-000853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This paper explores the impact of service area-level social deprivation on health centre clinical quality measures. Design Cross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres. Settings HRSA-funded health centres in the USA. Participants Our analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country. Results Higher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care. Conclusions This research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.
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Affiliation(s)
- Michael Topmiller
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jessica McCann
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jennifer Rankin
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Hank Hoang
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Joshua Bolton
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Alek Sripipatana
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
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Lebrun-Harris LA, Mendel Van Alstyne JA, Sripipatana A. Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers. Vaccine 2020; 38:6120-6126. [PMID: 32713680 PMCID: PMC7378489 DOI: 10.1016/j.vaccine.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION During the 2018-2019 influenza season, vaccination coverage among U.S. children was 62.6%. The purpose of this study was to estimate the prevalence of influenza vaccinations among pediatric patients seen in U.S. health centers, and to explore potential disparities in vaccination coverage among subpopulations. Funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services, these health centers provide primary and preventive care to underserved and vulnerable individuals and families in order to reduce health disparities based on economic, geographic, or cultural barriers. METHODS Cross-sectional data, analyzed in 2019, came from the most recent waves of the Health Center Patient Survey (2009, 2014). The sample consisted of children ages 2-17 years receiving care from HRSA-funded health centers. The outcome of interest was self- or parent-reported receipt of influenza vaccine in the past year. Multivariable logistic regression was used to estimate the adjusted prevalence rate ratios for the association between demographic characteristics (age, sex, race/ethnicity, poverty level, urban/rural residence, geographic region), health-related variables (receipt of well-child check-up, asthma diagnosis), and influenza vaccination. RESULTS Influenza vaccination coverage among pediatric health center patients increased from 46.6% in 2009 to 67.8% in 2014. In the adjusted model for 2014, there were few statistically significant differences in vaccination coverage among subpopulation groups, however American Indian/Alaska Native children had 31% increased vaccination coverage compared with non-Hispanic White children (aPRR: 1.31, 95% CI: 1.02-1.60) and children living in the South had 26% decreased vaccination coverage compared with those living in the Northeast (aPRR: 0.74, 95% CI: 0.54-0.93). CONCLUSIONS Influenza vaccination coverage among pediatric health center patients in 2014 exceeded the national average (as of 2018-2019), and few differences were found among at-risk subpopulations. HRSA-funded health centers are well-positioned to further increase the vaccination rate among children living in underserved communities.
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Affiliation(s)
- Lydie A Lebrun-Harris
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville MD, United States.
| | - Judith A Mendel Van Alstyne
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville MD, United States
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville MD, United States
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