Organizational Factors Associated with Disparities in Cervical and Colorectal Cancer Screening Rates in Community Health Centers

Chuang, Emmeline; Pourat, Nadereh; Chen, Xiao; Lee, Christopher; Zhou, Wenxing; Daniel, Marlon; Hoang, Hank; Sripipatana, Alek

doi:10.1353/hpu.2019.0014

Cited by 10 publications

(21 citation statements)

References 75 publications

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“…CHCs are often underfunded, are often short staffed, 9 are often prone to staff turnover, and lack other resources found in integrated care delivery systems. 10,11 In addition, CHCs serve a high-need patient population with complex problems such as health insurance instability and exposure to adverse social determinants of health (e.g., food/housing insecurity) and who are often in poorer health (e.g., higher prevalence of multimorbidity) than those seen outside CHCs, 12 impacting the performance of cancer-preventive care. 11 To date, little is known about what clinic-level factors differentiate CHCs that achieve high performance at 1, some, or all of these cancer-preventive care services.…”

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confidence: 99%

“…10,11 In addition, CHCs serve a high-need patient population with complex problems such as health insurance instability and exposure to adverse social determinants of health (e.g., food/housing insecurity) and who are often in poorer health (e.g., higher prevalence of multimorbidity) than those seen outside CHCs, 12 impacting the performance of cancer-preventive care. 11 To date, little is known about what clinic-level factors differentiate CHCs that achieve high performance at 1, some, or all of these cancer-preventive care services. Understanding the performance patterns in CHCs can inform the development of targeted interventions aimed at improving the adoption and spread of evidence-based practices.…”

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confidence: 99%

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Community Health Centers’ Performance in Cancer Screening and Prevention

Huguet

Hodes

Holderness

et al. 2022

American Journal of Preventive Medicine

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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.

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confidence: 99%

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confidence: 99%

Community Health Centers’ Performance in Cancer Screening and Prevention

Huguet

Hodes

Holderness

et al. 2022

American Journal of Preventive Medicine

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“…Next, we created a correlation matrix to explore the relationship between health centre quality and several health centre characteristics for each of the measures. Several patient characteristic control variables were explored based on previous literature regarding factors affecting health centre performance, [15][16][17] including veteran status, homelessness, lack of insurance, poverty and low-income rates, patients below age 18 and over age 65, race and ethnicity and non-English speakers. Potential health centre organisational controls included PCMH accreditation status, EHR system installed and in use by all sites and providers, urban/rural location, and number of health centre patients.…”

Section: Creating Adjusted Health Centre Clinical Quality Process and Outcome Measuresmentioning

confidence: 99%

Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres

et al. 2021

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ObjectiveThis paper explores the impact of service area-level social deprivation on health centre clinical quality measures.DesignCross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres.SettingsHRSA-funded health centres in the USA.ParticipantsOur analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country.ResultsHigher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care.ConclusionsThis research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.

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“…Given the demonstrated and potential efficacy of these factors in improving health care provided by health centers, HRSA has invested hundreds of millions of dollars to accelerate and optimize the adoption of health information technology, as well as incentivize the adoption of the patient-centered medical home model of care through its Quality Improvement Awards [30]. While previous studies have found positive effects of these innovations on access to care, quality of care, and disparities [26,32,33], additional analyses may examine their potential impact specifically on pediatric influenza vaccine uptake.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have identified several institutional factors which may contribute to health centers’ ability to provide equitable access to services across a broad range of clinical domains, such as cancer screening, chronic condition management, prenatal care, and well-visit check-ups. These institutional factors include the provision of supportive services (e.g., care coordination, health education, translation, transportation), early and widespread implementation of electronic health records, and recognition as patient-centered medical homes [26] , [32] , [33] . Strengthening access to and quality of primary care broadly through these efforts may translate to increased use of specific services including influenza vaccinations, and fewer missed opportunities for influenza vaccinations.…”

Section: Discussionmentioning

confidence: 99%

Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers

Lebrun‐Harris

Alstyne

Sripipatana

2020

Vaccine

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Introduction: During the 2018-2019 influenza season, vaccination coverage among U.S. children was 62.6%. The purpose of this study was to estimate the prevalence of influenza vaccinations among pediatric patients seen in U.S. health centers, and to explore potential disparities in vaccination coverage among subpopulations. Funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services, these health centers provide primary and preventive care to underserved and vulnerable individuals and families in order to reduce health disparities based on economic, geographic, or cultural barriers. Methods: Cross-sectional data, analyzed in 2019, came from the most recent waves of the Health Center Patient Survey (2009, 2014). The sample consisted of children ages 2-17 years receiving care from HRSAfunded health centers. The outcome of interest was self-or parent-reported receipt of influenza vaccine in the past year. Multivariable logistic regression was used to estimate the adjusted prevalence rate ratios for the association between demographic characteristics (age, sex, race/ethnicity, poverty level, urban/rural residence, geographic region), health-related variables (receipt of well-child checkup , asthma diagnosis), and influenza vaccination. Results: Influenza vaccination coverage among pediatric health center patients increased from 46.6% in 2009 to 67.8% in 2014. In the adjusted model for 2014, there were few statistically significant differences in vaccination coverage among subpopulation groups, however American Indian/Alaska Native children had 31% increased vaccination coverage compared with non-Hispanic White children (aPRR: 1.31, 95% CI: 1.02-1.60) and children living in the South had 26% decreased vaccination coverage compared with those living in the Northeast (aPRR: 0.74, 95% CI: 0.54-0.93). Conclusions: Influenza vaccination coverage among pediatric health center patients in 2014 exceeded the national average (as of 2018-2019), and few differences were found among at-risk subpopulations. HRSA-funded health centers are well-positioned to further increase the vaccination rate among children living in underserved communities.

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Organizational Factors Associated with Disparities in Cervical and Colorectal Cancer Screening Rates in Community Health Centers

Cited by 10 publications

References 75 publications

Community Health Centers’ Performance in Cancer Screening and Prevention

Community Health Centers’ Performance in Cancer Screening and Prevention

Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres

Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers

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