Links of Care: Evaluation of a Pilot Project to Improve Linkages Between Community Health Centers and the Medical Neighborhood for Colorectal Cancer Screening, Follow-up and Treatment

Authors:

Kara Riehman (Presenter)
American Cancer Society

Mary Doroshenk, American Cancer Society
Lesley Watson, American Cancer Society

Public Health Statement: In 2012, the Health Resources Service Administration began requiring Federally Qualified Health Centers (FQHCs) to measure and report colorectal cancer screening rates. FQHCs were concerned with securing follow up care for patients with an abnormal diagnosis, as follow-up services are often prohibitively expensive for low-income, uninsured patients.

Purpose: To address this challenge, the American Cancer Society, the Centers for Disease Control and Prevention, and the National Colorectal Cancer Roundtable implemented the Links of Care pilot program to promote collaboration between FQHCs serving low-income patients and specialty providers to secure diagnostic services. Goals were to increase timely access to specialists after an abnormal screening and implement evidence-based strategies to increase screening rates. Three FQHCs in geographically diverse locations participated in the pilot from 2015 to the present.

Methods/Approach: We conducted a process evaluation of the program through in-depth interviews with 24 FQHC and ACS staff.

Results: All FQHCs built successful collaborations with hospitals and gastroenterologists (GIs) and secured free screening and diagnostic colonoscopies through these partnerships. FQHCs successfully implemented strong screening navigation programs within their systems, ensuring referral and timely follow-up to diagnostic services. Screening rates increased and navigation led to improved show rates and adequate preparation for colonoscopies, which was crucial to maintaining strong relationships with the GIs and hospitals.

Conclusions/Implications: Successful strategies to build partnerships included identifying GI champions, making a cost savings case, emphasizing the role of navigators to secure good use of limited resources and strong care coordination and increasing show rates, and using data to create a ‘fair share’ model.