Community Health Centers’ Performance in Cancer Screening and Prevention

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.

In pursuit of equity in cancer care: Moving beyond the Affordable Care Act

“…One study found that in the CHC setting wherein health insurance is not a barrier to care, rates of colorectal and cervical cancer screening increased after implementation of the ACA; the same study found that in the CHC setting, rates of cervical cancer screening increased the most among Black patients in MES 36 . These advances may be driven in part by the ACA's preventive services provision 36–38 . Additionally, ACA Medicaid expansion was associated with improved rates of insurance coverage for patients with cancer who receive care at CHCs particularly in MES, 39 suggesting that Medicaid expansion greatly benefits patients who are socioeconomically disadvantaged 38 .…”

“…36 These advances may be driven in part by the ACA's preventive services provision. [36][37][38] Additionally, ACA Medicaid expansion was associated with improved rates of insurance coverage for patients with cancer who receive care at CHCs particularly in MES, 39 suggesting that Medicaid expansion greatly benefits patients who are socioeconomically disadvantaged. 38 These findings are encouraging because they demonstrate that policies that facilitate access to health insurance may improve equity in cancer care.…”

Impact of COVID-19 Pandemic on Assessing Tobacco Status in Community Health Centers

“…Many patients delayed seeking care for routine prevention and disease management due to limited in-person appointments and fear of traveling to/attending in-person visits. Since the start of the pandemic, several studies have shown a decline in receipt of preventive care [3][4][5][6] and chronic disease management. 7 Little is known about the impact of the pandemic on addressing tobacco use.…”

Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: an observational cohort study

“…CHC settings are important to study given that they provide primary care services, including smoking cessation services, to many uninsured or Medicaid-insured patients with higher rates of smoking than the general population [ 22 , 23 ]. National quality performance data show that CHCs have high rates of assessing and treating tobacco use among their patients [ 24 , 25 ]. We tested the hypotheses that cancer survivors in ACA expansion states who reported current smoking prior to the ACA expansion would have higher odds of smoking cessation, higher odds of having a cessation medication ordered, and increased primary care utilization post-ACA compared to those in non-expansion states.…”