Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation.

Olga Moshkovich,Michelle Chung,Alek Sripipatana,Laura Makaroff,Sue C Lin,Lydie Lebrun-Harris,Preeta Chidambaran

doi:10.1155/2015/182073

Abstract

Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS) persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs) have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH) transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen's Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs) and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited.

Highlights

Over the last 50 years, the incidence of cervical cancer has dramatically decreased as a result of available screening tests for early detection and intervention [1, 2]
We considered the following factors to ensure that the sample reflected the diversity of federally funded health centers (HCs) and their patients: total patient volume, geographical region, number of full-time clinicians per 10,000 medical patients, urban/rural location, cancer screening (CCS) rate adjusted quartile, patientcentered medical home (PCMH) recognition status, percentage of homeless patients, percentage of agricultural workers patients, percentage of uninsured patients, percentage of major racial/ethnic minority groups, and percentage of patients best served in a language other than English [25, 26]
This study sought to investigate barriers to CCS reported by HCs and proposed solutions to increase screening rates, among HCs undergoing PCMH transformation

Summary

Introduction

Over the last 50 years, the incidence of cervical cancer has dramatically decreased as a result of available screening tests for early detection and intervention [1, 2]. Health disparities persist in cervical cancer incidence and death rates for women from racial and ethnic minorities and those residing in rural and poor communities [3]. White women living in Appalachia have a much higher risk for developing cervical cancer than other white women [5]. Much of these disparities can be attributed to lack of screening, health insurance coverage, and access to health care [6]. Cervical cancer screening (CCS) interventions have been developed for minority populations; the efficacy of these interventions has been mixed [7,8,9]

Methods

Results

Discussion

Conclusion