Oregon Rural Practice-Based Research Network, Department of Family Medicine, and School of Public Health, Oregon Health & Science University, Portland, Oregon
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
Ann Fam Med. 2022 Mar-Apr;20(2):123-129. doi: 10.1370/afm.2772.
Mailed fecal immunochemical test (FIT) programs can facilitate colorectal cancer (CRC) screening. We sought to identify modifiable, clinic-level factors that distinguish primary care clinics with higher vs lower FIT completion rates in response to a centralized mailed FIT program.
We used baseline observational data from 15 clinics within a single urban federally qualified health center participating in a pragmatic trial to optimize a mailed FIT program. Clinic-level data included interviews with leadership using a guide informed by the Consolidated Framework for Implementation Research (CFIR) and FIT completion rates. We used template analysis to identify explanatory factors and configurational comparative methods to identify specific combinations of clinic-level conditions that uniquely distinguished clinics with higher and lower FIT completion rates.
We interviewed 39 clinic leaders and identified 58 potential explanatory factors representing clinic workflows and the CFIR inner setting domain. Clinic-level FIT completion rates ranged from 30% to 56%. The configurational model for clinics with higher rates (≥37%) featured any 1 of the following 3 factors related to support staff: (1) adding back- or front-office staff in past 12 months, (2) having staff help patients resolve barriers to CRC screening, and (3) having staff hand out FITs/educate patients. The model for clinics with lower rates involved the combined absence of these same 3 factors.
Three factors related to support staff differentiated clinics with higher and lower FIT completion rates. Adding nonphysician support staff and having those staff provide enabling services might help clinics optimize mailed FIT screening programs.
邮寄粪便免疫化学检测（FIT）方案可以促进结直肠癌（CRC）筛查。我们旨在确定可改变的、临床层面的因素，这些因素可以区分在集中邮寄 FIT 方案下完成率较高和较低的初级保健诊所。
我们使用来自参与一项实用试验的单一城市联邦合格健康中心的 15 个诊所的基线观察数据来优化邮寄 FIT 方案。诊所层面的数据包括使用实施研究综合框架（CFIR）指南对领导层进行的访谈以及 FIT 完成率。我们使用模板分析来识别解释因素，并使用配置比较方法来识别独特区分完成率较高和较低的诊所的具体诊所层面条件组合。
我们采访了 39 名诊所领导，确定了 58 个潜在的解释因素，这些因素代表了诊所的工作流程和 CFIR 内部环境领域。诊所层面的 FIT 完成率从 30%到 56%不等。完成率较高（≥37%）诊所的配置模型具有与支持人员相关的以下 3 个因素中的任何 1 个：（1）在过去 12 个月内增加了前后台工作人员，（2）有工作人员帮助患者解决 CRC 筛查障碍，（3）有工作人员发放 FIT/教育患者。完成率较低的诊所涉及这些相同的 3 个因素同时不存在。
与支持人员相关的三个因素可以区分完成率较高和较低的 FIT 诊所。增加非医师支持人员并让这些人员提供辅助服务可能有助于诊所优化邮寄 FIT 筛查方案。
