Partnering for Prevention: The Cancer Prevention and Control Research Network’s Collaborations with Federally Qualified Health Centers

Federally Qualified Health Centers As a Key Partner in Community-Clinical Linkages to Support HPV Vaccination

Authors:

Heather Brandt (Presenter)
University of South Carolina Arnold School of Public Health

Robin Vanderpool, University of Kentucky College of Public Health
Laura Seegmiller, University of Iowa College of Public Health
Lindsay Stradtman, University of Kentucky College of Public Health
Jason Daniel-Ulloa, University of Iowa College of Public Health
Thuy Vu, University of Washington School of Public Health
Vicky Taylor, Fred Hutchinson Cancer Research Center
Paige Farris, Oregon Health & Science University
Susan Curry, University of Iowa College of Public Health

Public Health Statement: Human papillomavirus (HPV) vaccination rates in the U.S. are suboptimal, requiring innovative partnerships—such as community-clinical linkages (CCLs)—to address this public health problem.

Purpose: Further evaluation is needed to understand what types of organizations participate in CCLs and how CCLs function. Investigators from the Centers for Disease Control and Prevention-funded Cancer Prevention and Control Research Network (CPCRN) examined CCLs dedicated to improving HPV vaccination rates across five geographically diverse communities.

Methods/Approach: A case study approach, using semi-structured interviews, was used to collect information describing two HPV vaccination-focused CCLs for each CPCRN site. Representatives from each CCL dyad provided descriptive information, including the type of CCL integration (e.g., mutual, community-focused, clinically-focused), impetus for the respective CCL, barriers and facilitators to effective linkages, and evaluation activities.

Results: Interviews were conducted with nine CCL dyads, including five with Federally Qualified Health Centers (FQHCs) serving as the clinical partner. CCLs that included FQHCs indicated a clinically-focused type of integration, and each of their community partners were non-profit organizations. Four FQHCs indicated that their CCLs were formed because of national or state HPV vaccination initiatives; three reported having funding for their CCLs.

Conclusions/Implications: FQHCs emerged as important clinical sites in cultivating HPV vaccination-focused CCLs. FQHCs have an established patient base, are well-respected within their communities, and maintain numerous connections with local organizations, which aid in establishing and sustaining CCLs. Study results will guide future HPV vaccination initiatives across CPCRN sites and contribute to research focused on CCLs as an evidence-based implementation strategy to improve HPV vaccination.

Implementation of Lung Cancer Screening Among Federally Qualified Health Centers (FQHCs) in the U.S.

Authors:

Genevieve Birkby (Presenter)
Case Western Reserve University

Susan Flocke, Case Western Reserve University
Robin Vanderpool, University of Kentucky, College of Public Health
Jan Eberth, University of South Carolina School of Public Health
Richard Hoffman, University of Iowa, College of Medicine
Daniel Reuland, University of North Carolina, School of Medicine
Steven Zeliadt, University of Washington

Public Health Statement:
While prevalence of tobacco use has declined over the past decade among some demographic groups, rates have remained steady and even increased among some socially and economically disadvantaged populations. Tobacco use disproportionately affects the health of people with low SES. Lower income smokers suffer from more diseases, such as lung cancer, than do smokers with higher incomes. Federally Qualified Health Centers (FQHCs) are organized to serve the poor and under-insured particularly in urban and rural locations and prior work has identified an exceptionally high burden of tobacco use among patient populations of FQHCs.

Purpose: This national survey assesses the current practices and capacity of Federally Qualified Health Centers (FQHCs) to implement Low Dose Computed Tomography (LDCT) for lung cancer screening.

Methods/Approach: We randomly sampled 267 FQHCs serving a population with tobacco use prevalence above the median of all 1202 FQHCs nationally. We invited medical directors from these centers to complete a web-based survey assessing current practices and resources for lung cancer screening.

Results: 112 (41%) FQHCs responded to the survey. All FQHCs are required to collect tobacco use data, however only 13% reported having data sufficiently detailed to identify patients eligible for screening and 6% have a lung cancer screening best practice alert. 42% reported that some FQHC providers offer screening; 38% reported that no providers do so, and 20% indicated they did not know if providers in their system are offering LDCT for lung cancer screening. Among FQHCs offering screening, 17% reported typically referring patients to a dedicated lung cancer screening program; 81% reported typically referring to a nearby radiology facility. Of those facilities offering screening, 6% were ordering more than 10 screening tests per month, 51% were ordering fewer than 10 tests, and 43% did not know their volume.

Conclusions/Implications: In this national sample of FQHCs with high tobacco-use populations, nearly half are offering LDCT lung cancer screening to patients, albeit at very low frequency. Substantial barriers to facilitating screening are difficulty systematically identifying eligible patients and lack of a lung cancer screening best practice alert.

Partnering for Prevention: The Cancer Prevention and Control Research Network’s Collaborations with Federally Qualified Health Centers

Authors:

Catherine Rohweder (Presenter)
UNC Chapel Hill

Daniela Friedman, Arnold School of Public Health
Jennifer Leeman, UNC Chapel Hill
Linda Ko, Fred Hutchinson Cancer Research Center
Karen Glanz, The University of Pennsylvania

Public Health Statement: Colorectal cancer (CRC) screening rates among U.S. adults 50-75 years old have increased; however, they remain lower than the national goal of 80% by 2018. Uninsured and low income populations are lagging behind, especially patients served by Federally Qualified Health Centers (FQHCs).

Purpose: To determine which evidence-based interventions (EBIs) and implementation strategies FQHCs are using to improve screening rates, the Cancer Prevention and Control Research Network (CPCRN) of the Prevention Research Centers (PRC) network conducted a survey of FQHCs in 9 states.

Methods/Approach: A web-based survey was developed to assess the use of EBIs from the Community Guide, implementation strategies adapted from two published taxonomies, preferences for training and technical assistance (TA), and clinic demographics. Survey links were sent to 148 FQHCs; 56 surveys were completed for a response rate of 37.8%.

Results: We conducted descriptive analyses and tabulated frequencies for: 1) EBIs; 2) implementation strategies; 3) desired topics for training and technical assistance; and 4) clinic characteristics. The top three EBIs were provider reminder and recall systems, one-on-one education, and provider assessment and feedback. The top three implementation strategies were identifying barriers to implementing EBIs, distributing CRC screening guidelines to providers, and integrating incremental changes over time to improve CRC screening. The topic most frequently requested for training and TA was patient navigation. Additional results will be presented.

Conclusions/Implications: These findings will inform in-depth follow-up interviews, and serve as a foundation for an implementation support curriculum to be disseminated nationally to FQHCs and organizations as part of the 80 by 2018 campaign.