California Department of Public Health, Sacramento, CA, USA.
American Cancer Society, Sacramento, CA, USA.
Cancer Control. 2024 Jan-Dec;31:10732748241255218. doi: 10.1177/10732748241255218.
We examined the extent to which funded satellite clinics could sustain the California Colon Cancer Control Program (C4P) strategies implemented in health systems to increase uptake of the fecal immunochemical test (FIT) or immunochemical fecal occult blood test (iFOBT) for colorectal cancer (CRC) screening in the absence of future C4P funds.
Seven health systems consisting of 38 satellite clinics participated in C4P to examine the sustainability of the program in the absence future Centers for Disease Control and Prevention (CDC) funding.
Quantitative and qualitative methods with a close and open-ended survey approach, and a prospective cohort design were used to examine the sustainability of the C4P in health systems.
A total of 61% of satellite clinics could not sustain funding stability. Only 26% could sustain funding stability. About, 71%, 26%, and 21% of the satellite clinics could sustain the small media platform, patient navigation services, and community health workers (CHWs), respectively. All the satellite clinics sustained the provider reminder system and professional development. Roughly, 71% and 42% of funded satellite clinics could not sustain the patient navigators and CHWs, respectively. The satellite clinics that could sustain funding stability, sustained patient navigation services and CHWs. Health systems that could not sustain funding stability, could not sustain patient navigation services and CHWs. Qualitatively, the need to support uninsured priority populations, health educators, patient navigators, care coordination activities, outreach services, and provision of enhanced services emerged. The need to support enhanced quality measures, expansion of funding, Medi-Cal Public Hospital Redesign and Incentive coverage, health plan, community linkages, resource sharing, and best practices specifically on CRC screening emerged. Themes such as automated reminder, limited personalized care delivery and capacity, transportation barriers, staff salary, expansion of care through patient navigation, and culturally appropriate media campaign also emerged.
Overall, to address sustainability barriers, funding stability should be maintained in the health systems.
本研究旨在探讨在没有未来加州结直肠癌控制项目（C4P）基金的情况下，资金支持的卫星诊所能够在多大程度上维持 C4P 项目在卫生系统中实施的策略，以提高粪便免疫化学试验（FIT）或免疫化学粪便潜血试验（iFOBT）用于结直肠癌（CRC）筛查的采用率。
由 38 家卫星诊所组成的 7 个卫生系统参与了 C4P，以检验在没有未来疾病控制与预防中心（CDC）资金的情况下该项目的可持续性。
采用定量和定性方法，采用封闭式和开放式调查方法以及前瞻性队列设计，以检验 C4P 在卫生系统中的可持续性。
共有 61%的卫星诊所无法维持资金稳定，只有 26%的诊所能够维持资金稳定。大约 71%、26%和 21%的卫星诊所能够分别维持小型媒体平台、患者导航服务和社区卫生工作者（CHW）。所有的卫星诊所都维持了提供提醒服务和专业发展。大约 71%和 42%的资金支持卫星诊所分别无法维持患者导航员和 CHW。能够维持资金稳定的卫星诊所维持了患者导航服务和 CHW。无法维持资金稳定的卫生系统无法维持患者导航服务和 CHW。定性研究结果表明，需要支持没有保险的优先人群、健康教育者、患者导航员、护理协调活动、外展服务以及提供增强服务。需要支持增强质量措施、扩大资金覆盖范围、加州公共医院重新设计和激励计划、医疗保健计划、社区联系、资源共享以及特别针对 CRC 筛查的最佳实践。还出现了一些主题，如自动提醒、个性化护理提供能力有限、交通障碍、员工工资、通过患者导航扩大护理范围以及文化适宜的媒体宣传。
总体而言，为了解决可持续性障碍，应在卫生系统中维持资金稳定。
