Using Practice Facilitation to Increase Rates of Colorectal Cancer Screening in Community Health Centers, North Carolina, 2012–2013: Feasibility, Facilitators, and Barriers

Abstract

IntroductionPractice facilitation involves trained individuals working with practice staff to conduct quality improvement activities and support delivery of evidence-based clinical services. We examined the feasibility of using practice facilitation to assist federally qualified health centers (FQHCs) to increase colorectal cancer screening rates in North Carolina. MethodsThe intervention consisted of 12 months of facilitation in 3 FQHCs. We conducted chart audits to obtain data on changes in documented recommendation for colorectal cancer screening and completed screening. Key informant interviews provided qualitative data on barriers to and facilitators of implementing office systems.ResultsOverall, the percentage of eligible patients with a documented colorectal cancer screening recommendation increased from 15% to 29% (P < .001). The percentage of patients up to date with colorectal cancer screening rose from 23% to 34% (P = .03). Key informants in all 3 clinics said the implementation support from the practice facilitator was critical for initiating or improving office systems and that modifying the electronic medical record was the biggest challenge and most time-consuming aspect of implementing office systems changes. Other barriers were staff turnover and reluctance on the part of local gastroenterology practices to perform free or low-cost diagnostic colonoscopies for uninsured or underinsured patients.ConclusionPractice facilitation is a feasible, acceptable, and promising approach for supporting universal colorectal cancer screening in FQHCs. A larger-scale study is warranted.

Practice Facilitators’ and Leaders’ Perspectives on a Facilitated Quality Improvement Program

“…Although implementation studies have been undertaken in the past, they have generally been limited to other countries, 8,9 and none have considered the perspectives of both practice facilitators and practice leaders, who have distinct but complementary and vital roles in quality improvement. 3,10 The purpose of this article is to describe enablers and barriers to a practice facilitator-supported quality improvement program aimed at improving preventive cardiology within small and medium-size independent primary care practices. This qualitative study is unique in its inclusion of perspectives from both practice leaders and practice facilitators, which allows for examination of where their perspectives align or diverge.…”

Effect of an equal‐access military health system on racial disparities in colorectal cancer screening

“…Among black patients, insurance status and financial concerns have been identified as overwhelming barriers to health care preventative services. [35][36][37] We acknowledge that people who join the military may not have the same barriers with health literacy because there is a selection process to join the military that requires minimum education levels. [29][30][31][32] Within our study population, this barrier is eliminated because enrollees are universally provided insurance.…”

“…8,33,34 Additional targeted interventions are needed to improve screening among racial groups and subpopulations that may encounter these issues as their primary barriers to age-appropriate screening. [35][36][37] We acknowledge that people who join the military may not have the same barriers with health literacy because there is a selection process to join the military that requires minimum education levels.…”

Two Medicaid health plans’ models and motivations for improving colorectal cancer screening rates

“…program and in general to using FIT [14,18,[20][21][22]. However, community-based clinics face a variety of challenges implementing such a program, including turnover in key staff, competing time pressures, electronic health records (EHRs) that are incomplete or not designed to support population-based screening, challenges with staffing a centralized mailing program, and colonoscopy access [11,20,21,23].…”