System Strategies for Colorectal Cancer Screening at Federally Qualified Health Centers

Abstract

Objective We assessed the protocols and systems processes for colorectal cancer (CRC) screening at federally qualified health centers (FQHC) in four midwestern states. Methods We identified 49 FQHCs in 4 states. In January, 2013, we mailed their medical directors a 49-item questionnaire about policies on CRC screening, use of electronic medical records, types of CRC screening recommended, clinic tracking systems, referrals for colonoscopy, and barriers to providing CRC. Results Forty-four (90%) questionnaires were returned. Thirty-three of the respondents (75%) estimated the proportion of their patients up-to-date with CRC screening, with a mean of 35%. One major barrier to screening was inability to provide colonoscopy for patients with a positive fecal occult blood test (59%). The correlation of system strategies and estimated percent of patients up-to-date with CRC screening was 0.43 (p = 0.01). Conclusions CRC system strategies were associated with higher CRC screening rates. Implementing system strategies for CRC screening takes time and effort and is important to maintain to help prevent or cure many cases of CRC, the second leading cause of cancer in the United States.

A randomized controlled trial of a multicomponent, targeted, low‐literacy educational intervention compared with a nontargeted intervention to boost colorectal cancer screening with fecal immunochemical testing in community clinics

“…Finally, logistical, system, and structural impediments, such as low clinic attention to CRC screening promotion, underdeveloped clinic tracking systems, and inability to offer follow-up colonoscopy and care for those with a positive stool blood test may get in the way of CRC screening programs. 9, 15, 16 …”

“…17 Recently, high sensitivity and high specificity fecal occult blood tests (FOBT) and fecal immunochemical tests (FIT) have emerged as a preferred initial screening modality within clinics due to convenience, ease of use, and low cost compared with colonoscopy. 16, 18, 19 FOBT/FIT may help reduce CRC screening disparities and overcome a number of previously mentioned factors that often account for sub-optimal CRC screening rates.…”

“…Finally, logistical, systemic, and structural impediments such as low clinic attention to CRC screening promotion, underdeveloped clinic tracking systems, and an inability to offer follow-up colonoscopy and care for those with a positive stool blood test may get in the way of CRC screening programs. 9,15,16 Federally qualified health centers (FQHCs) and other community health clinics (CHCs) provide comprehensive primary health care for underserved patients. 17 Recently, high-sensitivity and high-specificity fecal occult blood tests (FOBT) and fecal immunochemical tests (FIT) have emerged as a preferred initial screening modality within clinics due to convenience, ease of use, and low cost compared with colonoscopy.…”

Characteristics of Effective Colorectal Cancer Screening Navigation Programs in Federally Qualified Health Centers: A Systematic Review

“…These protocol changes resulted in a 2.5 greater odds of completing an FOBT. In an investigation of CRC protocol and screening prevalence at 49 FQHCs in the Midwest, Daly et al 26 similarly found a significant correlation between the number of protocols employed and the percentage of patients that were screening compliant. In addition to protocol changes, DeGroff et al 27 proposed 10 key features to establish a successful CRC screening navigation program: 1) define the patient population and its unique barriers, 2) apply a theoretical framework, 3) establish entry and exit points for navigation services, 4) determine a location where navigation services will be performed, 5) provide communication training, 6) identify the navigation services offered and navigator responsibilities, 7) determine qualifications for the navigator, 8) design navigator training, 9) identify navigation supervision, and 10) evaluate navigation services.…”

Test Characteristics of Faecal Immunochemical Tests (FIT) Compared with Optical Colonoscopy

“…We chose CLIA-waived FITs because many resource-poor settings are not able to provide universal access to colonoscopy, due to lack of colonoscopy providers, prohibitive costs, or both. 14,40,41 The FIT is, therefore, potentially a very useful test for resourcepoor settings, and has also been recommended for other settings. 40,42,43 …”