Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
Int J Environ Res Public Health. 2024 Jan 24;21(2):126. doi: 10.3390/ijerph21020126.
Colorectal cancer (CRC) screening is effective in the prevention and early detection of cancer. Implementing evidence-based screening guidelines remains a challenge, especially in Federally Qualified Health Centers (FQHCs), where current rates (43%) are lower than national goals (80%), and even lower in populations with limited English proficiency (LEP) who experience increased barriers to care related to systemic inequities.
This quality improvement (QI) initiative began in 2016, focused on utilizing patient navigation and practice facilitation to addressing systemic inequities and barriers to care to increase CRC screening rates at an urban FQHC, with two clinical locations (the intervention and control sites) serving a diverse population through culturally tailored education and navigation.
Between August 2016 and December 2018, CRC screening rates increased significantly from 31% to 59% at the intervention site ( < 0.001), with the most notable change in patients with LEP. Since 2018 through December 2022, navigation and practice facilitation expanded to all clinics, and the overall CRC screening rates continued to increase from 43% to 50%, demonstrating the effectiveness of patient navigation to address systemic inequities.
This multilevel intervention addressed structural inequities and barriers to care by implementing evidence-based guidelines into practice, and combining patient navigation and practice facilitation to successfully increase the CRC screening rates at this FQHC.
结直肠癌（CRC）筛查在癌症的预防和早期发现方面非常有效。实施基于证据的筛查指南仍然是一个挑战，尤其是在联邦合格的健康中心（FQHC），目前的筛查率（43%）低于国家目标（80%），而在英语水平有限的人群（LEP）中，由于与系统性不平等相关的护理增加障碍，这一比率甚至更低。
这项质量改进（QI）倡议始于 2016 年，专注于利用患者导航和实践促进，解决系统性不平等和护理障碍，以提高城市 FQHC 的 CRC 筛查率，该 FQHC 有两个临床地点（干预和对照地点）通过文化适应性教育和导航为不同人群提供服务。
2016 年 8 月至 2018 年 12 月期间，干预点的 CRC 筛查率从 31%显著增加到 59%（<0.001），LEP 患者的变化最为显著。自 2018 年 12 月至 2022 年 12 月，导航和实践促进已扩展到所有诊所，CRC 筛查率继续从 43%增加到 50%，这表明患者导航在解决系统性不平等方面是有效的。
这项多层次干预通过将循证指南付诸实践，并结合患者导航和实践促进，解决了结构性不平等和护理障碍，成功提高了该 FQHC 的 CRC 筛查率。
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