ASPO Abstracts

Using a process map to identify workflow and intervention points for colorectal cancer screening in community health centers

Authors: DaCosta C, Bradley SM, Tucker S, Rabin BA, Hurst S, Gupta S, Liu L, Alvarez F, James A, Nodora J

Category: Cancer Health Disparities
Conference Year: 2020

Abstract Body:
PURPOSE Few community health centers (CHCs) have consistently implemented and sustained evidence-based interventions (EBIs) to increase colorectal cancer (CRC) screening. Our study aimed to understand CRC screening processes in a San Diego County CHC and identify intervention points. METHODS Guided by the contextually expanded RE-AIM framework (PRISM), secondary data were extracted from CHC databases along with new data requests to identify contextual factors influencing CRC screening processes. A CHC-based study coordinator recruited key clinic personnel (e.g., clinic’s executive team, clinic managers, referral managers, quality improvement specialists, lab personnel, providers, and referral gastroenterologists) to participate in surveys and in-depth interviews. Adapted process maps, a tool for visualizing the CRC screening process, were developed with the CHC as a strategy to identify key CRC screening intervention points. RESULTS Our partnered CHC has 4 clinic sites serving CRC screening age-eligible patients. Patients are primarily racial/ethnic minorities (77%) with an income status at or below the federal poverty line (98%). The CRC screening rate at the CHC remains low (59%), compared to the American Cancer Society target (80%). We found that the CRC screening process begins with patient screening reminders via mailed letters and provider recommendation at appointments. Despite receiving instructions for CRC screening kits, some kits are completed improperly. Another intervention point was found in the documentation process of colonoscopy results. Clinic personnel reported inaccuracy in patient’s electronic health records due to improper naming of documents. CONCLUSION Our results show the need for multi-component implementation strategies with potential intervention points for CRC screening kit distribution and completion, as well as the documentation for the CRC screening process. These include multi-component implementation strategies such as phone client reminders, reducing structural barriers (e.g. appointment scheduling, alternative screening sites, add clinic hours, transportation, language translation, and childcare) and provider feedback (i.e., describe provider performance and compare with a goal or standard).

Keywords: colorectal cancer screening