Abstract
Although mortality rates of colorectal cancer (CRC) can be significantly reduced through increased screening, rural communities are still experiencing lower rates of screening compared to urban counterparts. Understanding and eliminating barriers to cancer screening will decrease cancer burden and lead to substantial gains in quality and quantity of life for rural populations. However, existing studies have shown inconsistent findings and fail to address how contextual and provider-level factors impact CRC screening in addition to individual-level factors. The purpose of the study is to examine multi-level factors related to CRC screening, and providers' perception of barriers and facilitators of CRC screening in rural patients cared for by accountable care organization (ACO) clinics. This is a convergent mixed method design. For the quantitative component, multiple data sources, such as electronic health records (EHRs), Area Resource File (ARF), and provider survey data, will be used to examine patient-, provider-, clinic-, and county-level factors. About 21,729 rural patients aged between 50 and 75 years who visited the participating ACO clinics in the past 12 months are included in the quantitative analysis. The qualitative methods include semi-structured in-depth interviews with healthcare professionals in selected rural clinics. Both quantitative and qualitative data will be merged for result interpretation. Quantitative data identifies "what" factors influence CRC screening, while qualitative data explores "how" these factors interact with CRC screening. The study setting is 10 ACO clinics located in nine rural Nebraska counties. This will be the first study examining multi-level factors related to CRC screening in the new healthcare delivery system (i.e., ACO clinics) in rural communities. The study findings will enhance our understanding of how the ACO model, particularly in rural areas, interacts with provider- and patient-level factors influencing the CRC screening rate of rural patients.
Highlights
Mortality rates of colorectal cancer (CRC) can be significantly reduced through increased screening, rural communities are still experiencing lower rates of screening compared to urban counterparts
The study was approved by the University of Nebraska Medical Center Institutional Review Board (IRB) and all participating rural accountable care organization (ACO) clinics, receiving the number of IRB PROTOCOL # 352-15-EP
The evidence of how the new rural ACO clinics interact with county, provider- and provider-level factors and the combined effects on cancer screening is missing in rural settings
Summary
Mortality rates of colorectal cancer (CRC) can be significantly reduced through increased screening, rural communities are still experiencing lower rates of screening compared to urban counterparts. The study findings will enhance our understanding of how the ACO model, in rural areas, interacts with provider- and patient-level factors influencing the CRC screening rate of rural patients. The US Preventive Services Task Force recommends that adults aged between 50 and 75 have a CRC screening, including fecal occult blood testing (FOBT) annually, sigmoidoscopy every 5 years, or colonoscopy every 10 years[4]. The decrease in both cancer incidence and death rates was significantly associated with the uptake of cancer screening and improved early detection[1]. Remote rural residents had the lowest screening rates overall (45%)[6]
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