Kim Jungyoon, Young Lufei, Bekmuratova Sarbinaz, Schober Daniel J, Wang Hongmei, Roy Shreya, Bhuyan Soumitra S, Schumaker Alice, Chen Li-Wu
University of Nebraska Medical Center Omaha NE 68198 USA.
Augusta University, Augusta, GA 30912 USA.
Rural Remote Health. 2017 Jan-Mar;17(1):4187. doi: 10.22605/rrh4187. Epub 2017 Mar 29.
Despite the known benefits of colorectal cancer (CRC) screening, rural areas have consistently reported lower screening rates than their urban counterparts. Alternative healthcare delivery models, such as accountable care organizations (ACOs), have the potential to increase CRC rates through collaboration among healthcare providers with the aim of improving quality and decreasing cost. However, researchers have not sufficiently explored how this innovative model could influence the promotion of cancer screening. The purpose of the study was to explore the mechanism of how CRC screening can be promoted in ACO-participating rural primary care clinics.
The study collected qualitative data from in-depth interviews with 21 healthcare professionals employed in ACO-participating primary care clinics in rural Nebraska. Participants were asked about their views on opportunities and challenges to promote CRC screening in an ACO context. Data were analyzed using a grounded theory approach.
The study found that the new healthcare delivery model can offer opportunities to promote cancer screening in rural areas through enhanced electronic health record use, information sharing and collaborative learning within ACO networks, use of standardized quality measures and performance feedback, a shift to preventive/comprehensive care, adoption of team-based care, and empowered care coordinators. The perceived challenges were found in financial instability, increased staff workload, lack of provider training/education, and lack of resources in rural areas.
This study found that the innovative care delivery model, ACO, could provide a well-designed platform for promoting CRC screening in rural areas, if sustainable resources (eg finance, health providers, and education) are provided. This study provides 'practical' information to identify effective and sustainable intervention programs to promote preventive screening. Further efforts are needed to facilitate delivery system reforms in rural primary care, such as improving performance evaluation measures and methods.
尽管结直肠癌（CRC）筛查有诸多益处，但农村地区的筛查率一直低于城市地区。诸如 accountable care organizations（ACO，可问责医疗组织）等替代医疗服务提供模式，有潜力通过医疗服务提供者之间的协作提高 CRC 筛查率，旨在提升质量并降低成本。然而，研究人员尚未充分探讨这种创新模式如何影响癌症筛查的推广。本研究的目的是探讨在参与 ACO 的农村初级保健诊所中促进 CRC 筛查的机制。
本研究通过对在内布拉斯加州农村地区参与 ACO 的初级保健诊所工作的 21 名医疗专业人员进行深入访谈，收集了定性数据。参与者被问及他们对在 ACO 背景下促进 CRC 筛查的机遇和挑战的看法。使用扎根理论方法对数据进行了分析。
研究发现，新的医疗服务提供模式可以通过加强电子健康记录的使用、ACO 网络内的信息共享和协作学习、使用标准化质量指标和绩效反馈、转向预防/综合护理、采用团队式护理以及赋予护理协调员权力，为促进农村地区的癌症筛查提供机会。所察觉到的挑战包括财务不稳定、工作人员工作量增加、缺乏提供者培训/教育以及农村地区资源匮乏。
本研究发现，如果提供可持续的资源（如资金、医疗服务提供者和教育），创新的医疗服务提供模式 ACO 可以为促进农村地区的 CRC 筛查提供一个精心设计的平台。本研究提供了“实用”信息，以确定促进预防性筛查的有效且可持续的干预项目。需要进一步努力推动农村初级保健的服务体系改革，例如改进绩效评估措施和方法。
