Laura A Brady1, Laurene M Tumiel-Berhalter1,2, Laura A Schad3, Alexandrea Bentham1, Karen Vitale4, Amanda Norton5, Gary Noronha6, Carlos Swanger6,7, Christopher P Morley3. 1. Department of Family Medicine, State University of New York (SUNY) University at Buffalo, Buffalo, NY. 2. University at Buffalo Clinical and Translational Science Institute, Buffalo, NY. 3. Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY. 4. University of Rochester Clinical and Translational Science Institute, Rochester NY. 5. A. Mandatory, Inc. (consulting for SUNY Upstate Medical University), Groton, NY. 6. Center for Primary Care, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY. 7. Health Reach for the Homeless, Rochester Regional Health, Rochester, NY.
Abstract
PURPOSE: Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters. METHODS: Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each practice facilitation period, focus groups and key informant interviews were conducted with participating personnel. Content analysis was performed annually to identify barriers and promoters. A comprehensive final analysis was performed at project end. RESULTS: Barriers included system-level (inconsistent communication with specialists, electronic health record system transitions, ownership changes) and practice-level challenges (staff turnover, inconsistent data entry, QI fatigue) that compound patient-level challenges of transportation, cost, and health literacy. Cyclical barriers like staff turnover returned despite attempts to resolve them, while successful implementation was promoted by reducing patients' structural barriers, adapting interventions to existing practice priorities, and enacting officewide policies. During the QI project, practices became aware of the impact of social determinants of health on patients' screening decisions. CONCLUSIONS: The project's longitudinal design enabled identification of key barriers that reduced accuracy of practices' screening rates and increased risk of patients falling through the cracks. Identified promoters can help sustain interventions to increase screenings.
PURPOSE: Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters. METHODS: Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each practice facilitation period, focus groups and key informant interviews were conducted with participating personnel. Content analysis was performed annually to identify barriers and promoters. A comprehensive final analysis was performed at project end. RESULTS: Barriers included system-level (inconsistent communication with specialists, electronic health record system transitions, ownership changes) and practice-level challenges (staff turnover, inconsistent data entry, QI fatigue) that compound patient-level challenges of transportation, cost, and health literacy. Cyclical barriers like staff turnover returned despite attempts to resolve them, while successful implementation was promoted by reducing patients' structural barriers, adapting interventions to existing practice priorities, and enacting officewide policies. During the QI project, practices became aware of the impact of social determinants of health on patients' screening decisions. CONCLUSIONS: The project's longitudinal design enabled identification of key barriers that reduced accuracy of practices' screening rates and increased risk of patients falling through the cracks. Identified promoters can help sustain interventions to increase screenings.
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