Clinic Factors Associated With Mailed Fecal Immunochemical Test (FIT) Completion: The Difference-Making Role of Support Staff

Abstract

PURPOSE Mailed fecal immunochemical test (FIT) programs can facilitate colorectal cancer (CRC) screening. We sought to identify modifiable, clinic-level factors that distinguish primary care clinics with higher vs lower FIT completion rates in response to a centralized mailed FIT program. METHODSWe used baseline observational data from 15 clinics within a single urban federally qualified health center participating in a pragmatic trial to optimize a mailed FIT program. Clinic-level data included interviews with leadership using a guide informed by the Consolidated Framework for Implementation Research (CFIR) and FIT completion rates. We used template analysis to identify explanatory factors and configurational comparative methods to identify specific combinations of clinic-level conditions that uniquely distinguished clinics with higher and lower FIT completion rates. RESULTSWe interviewed 39 clinic leaders and identified 58 potential explanatory factors representing clinic workflows and the CFIR inner setting domain. Clinic-level FIT completion rates ranged from 30% to 56%. The configurational model for clinics with higher rates (≥37%) featured any 1 of the following 3 factors related to support staff:(1) adding back-or front-office staff in past 12 months, (2) having staff help patients resolve barriers to CRC screening, and (3) having staff hand out FITs/educate patients. The model for clinics with lower rates involved the combined absence of these same 3 factors.CONCLUSIONS Three factors related to support staff differentiated clinics with higher and lower FIT completion rates. Adding nonphysician support staff and having those staff provide enabling services might help clinics optimize mailed FIT screening programs.

Implementation of a novel program to support colorectal cancer screening in a community health center consortium before and after the onset of COVID-19: a qualitative study of stakeholders’ perspectives

“…Also, considering the socioeconomic profile of the population served at SFCCC, the critical housing situation in San Francisco, and the process to complete and return a FIT kit, it is not surprising that housing instability was the most salient deterrent of CRC screening identified in our study. On the other hand, and in line with previous research, the inner setting barriers described by participants were related to the lack of resources (i.e., staff and materials) and lack of support from individuals in leadership positions within CHCs [ 13 – 15 , 21 , 24 ]. Finally, process barriers corresponded to limitations in the planning and execution of screening strategies, particularly in the collection and flow of information, and in the management of patients with abnormal FITs.…”

Data Challenges in Identifying Patients Due for Colorectal Cancer Screening in Rural Clinics

“…More robust analysis for small sample sizes (eg, Configurational Comparative Methods) could determine the combination of clinic and health plan characteristics that are linked to successful identification of eligible patients. [54][55][56] Research could also explore what kinds of EHR supports would benefit clinics with limited staff, or the potential for interoperable clinical decision support tools to enhance other innovations, such as health information exchanges, centralized EHR systems across multiple clinics (ie, OCHIN, "not an acronym"), or the use of remote digital devices that link to health records. Future qualitative research is needed to understand the additional key barriers and facilitators to population-level data reporting and what changes could facilitate data reporting on patients due for preventive care.…”

Improving colorectal cancer screening in rural primary care: Preliminary effectiveness and implementation of a collaborative mailed fecal immunochemical test pilot

“…Population outreach programs like mailed FIT and visit‐based strategies are both important to maximize CRC screening completion rates 9,17 . Recent work by our team suggests that activities of clinic‐based support staff influence patient response rates on centralized mailed FIT programs 70 . One strength of the collaborative approach is that administrative activities and program costs are covered by the health plan and thus reduce clinic burden (eg, addressing, stamping, and stuffing envelopes).…”

“…9,17 Recent work by our team suggests that activities of clinic-based support staff influence patient response rates on centralized mailed FIT programs. 70 One strength of the collaborative approach is that administrative activities and program costs are covered by the health plan and thus reduce clinic burden (eg, addressing, stamping, and stuffing envelopes). While a growing body of work emphasizes how reminder calls or alerts for mailed FIT programs can increase completion rates and lead to cost savings overall-these tasks may be challenging for individual clinics to complete.…”