Federally Qualified Health Centers Research Articles

Exploring the feasibility of Recovery Management Checkups for Primary Care in a Federally Qualified Health Center

IntroductionPrimary care settings present an opportunity for alcohol and substance use disorder (A/SUD) screening and treatment referral. However, there are recognized deficiencies in widely used treatment referral approaches, including acute care connections, vs. those that can support longer-term recovery. Recovery Management Checkups for Primary Care (RMC-PC) is an intervention with an evidence base for improving treatment referral and subsequent recovery for primary care patients; however, the intervention has never been fully implemented outside of a research context. We conducted a feasibility study to inform a future hybrid study of RMC-PC that will test the implementation and effectiveness of the intervention in primary care practice.MethodWe used a convergent mixed method design. The study’s setting was a Federally Qualified Health Center (FQHC) located in a large midwestern city. RMC-PC linkage services were administered by one of two treatment linkage managers: an FQHC linkage manager (F-LM) and a research staff linkage manager (R-LM). Quantitative data included (a) rates of positive A/SUD screening among a group of FQHC patients and (b) linkage manager service data (e.g., rate of successful meeting completion and days to completing of key events). Qualitative data included (c) an assessment of linkage manager’s motivational interviewing performance and (d) a focus group with FQHC staff focused on their perspectives on RMC-PC implementation determinants. Quantitative data were summarized using descriptive statistics, and linkage manager performance was compared. Qualitative data were analyzed using a hybrid deductive-inductive process.ResultsFifty percent of patients screened met moderate-high A/SUD risk. Eleven of 16 recruited patients completed at least one linkage manager meeting, with 63% completing both meetings. The F-LM delivered RMC-PC services alongside other duties successfully; however, three primary barriers to FQHC implementation were identified (difficulties applying motivational interviewing, incompatibilities of screening with FQHC technology and workflow, and lack of billing mechanism to support services).ConclusionRMC-PC is feasible for FQHC staff to deliver, though issues identified must be considered to ensure successful and sustainable implementation. Knowledge gained will inform a packaged implementation strategy that will be used in a future hybrid trial.

An exploration of attitudes regarding the use of a state tobacco Quitline for smoking cessation among low-income adults with a history of smoking.

Smoking rates among low-income smokers are significantly elevated. State tobacco quitlines offer free and evidence-based treatments for smokers living in that state. This study investigated knowledge, attitudes, and beliefs associated with engagement with the Illinois Tobacco Quitline among confirmed smoking patients at a Federally Qualified Health Center (FQHC). Further goals were to obtain recommendations for strategies to improve patient awareness and engagement. Data for this study were collected from August to October 2021 from patients receiving care in an FQHC in a large midwestern city in the USA. Clinic-based recruitment was used to enroll a sample of adult current smokers. In-depth interviews and brief surveys were completed with a volunteer sample of patients recruited from an FQHC. The interviews took approximately 60 minutes. Data analysis used descriptive statistics to summarize the responses to the study and deductive thematic analysis to analyze the qualitative interviews. Study participants (n=25) were primarily male, African American, and middle-aged (mean age: 52.5 years). The majority were daily smokers. Over half had heard about the Quitline from sources such as radio advertisements, but usage was low. Barriers to use included low motivation to quit, questions about effectiveness, and poor success with prior Quitline attempts. Participants described factors that would increase the appeal of the Quitline, including testimonials, personalization, and an empathetic approach. Participants were asked about the acceptability of receiving information about the Quitline via patient portals, and most were in support. Interventions are needed to raise awareness and utilization of Quitlines among patients receiving care in FQHC settings. Distribution of Quitline information via patient portals is an acceptable strategy for increasing awareness of services.

A qualitative exploration of the client-provider relationship and its role in discussing sexual health and HIV among African American women in the US South

ObjectiveSexually transmitted infections (STIs), including HIV, are a key contributor to psychological and physical morbidity across the United States (US). African American (AA) women are disproportionately impacted by STIs, particularly in the Deep South of the US. Strong patient-provider communication can help to increase client understanding of STI prevention and treatment options. This study aimed to explore factors influencing effective patient-provider relationships and communication around STIs (including HIV) and sexual health broadly, which will ultimately inform the refinement of a patient-provider communication tool for discussing PrEP as an HIV prevention method. MethodsAs part of a larger study focused on PrEP implementation, in-depth, semi-structured qualitative interviews were conducted among cisgender AA women who are PrEP-eligible, both with and without PrEP experience, as well as providers from three federally qualified health centers (FQHCs) and HIV service agencies in Alabama. Data were analyzed using content analysis. ResultsA total of 41 participants enrolled, including 21 clients (n = 6 PrEP experienced; n = 15 PrEP naïve) and 20 providers. Qualitative data were organized across the following domains: meaning of health and sexual health, factors influencing the client-provider relationship, and factors influencing sexual health discussions among clients and providers. Key factors influencing client-provider relationships were organized at client, provider, and clinic levels. Factors impacting sexual health discussions between clients and providers were organized at client, provider, and structural levels. ConclusionThese interviews identified key determinants of effective client-provider communication pertaining to sexual health among cisgender AA women in the US South who were receiving care at FQHCs and HIV service organizations. Individual, provider, and clinic-level factors were identified that have implications for designing sexual health interventions for cisgender AA women.

Potential benefits of incorporating social determinants of health screening on comprehensive medication management effectiveness.

Increasingly, pharmacists are asked to incorporate social determinants of health (SDoH) identification and referral into clinical practice. However, to date, no studies have evaluated clinical changes from embedding SDoH screening into the delivery of comprehensive medication management (CMM) in patients with chronic conditions. To examine the clinical effectiveness of implementing a clinical pharmacist-led SDoH screening and referral process as part of CMM encounters across a network of 7 Federally Qualified Health Centers (FQHCs). We used a retrospective cohort design to evaluate the effectiveness of integrating SDoH screening into CMM across a network of 7 FQHCs. A difference-in-difference approach was used to compare the effectiveness of CMM between patients with and without SDoH needs on the probability of achieving clinical control for blood pressure (<140 systolic/90 diastolic mm Hg) and diabetes (<9% hemoglobin A1c). Among 807 patients receiving CMM in 2023, 595 (74%) were screened for SDoH. 55.1% of patients screened had 1 or more SDoH, most commonly facing barriers related to insurance (22.0%), language (11.3%), transportation (9.1%), health behaviors (7.1%), income/employment (5.9%), and food insecurity (5.6%). Comparing patients with SDoH needs with those without, the proportion of patients controlled at baseline was 66.3% vs 72.3% for hypertension and 39.0% vs 75.4% for diabetes, respectively. Following a CMM encounter, the proportion of patients who achieved blood pressure control increased 7.6% more (P = 0.225) among patients with SDoH needs than in those without SDoH, whereas diabetes control rates increased 13.3% more (P = 0.143). Although not statistically significant, the results of this pilot evaluation suggest the potential for meaningful clinical improvements from screening and referral of SDoH needs as a part of CMM encounters. These results should be corroborated using a larger, more robust study design.

Recruitment and Retention in the National Diabetes Prevention Program Lifestyle Change Program in Two Federally Qualified Health Centers in Rural Hawai'i.

Prediabetes disproportionately affects racial and ethnic minority groups in Hawai'i. The National Diabetes Prevention Program lifestyle change program (National DPP LCP) decreases the risk of developing diabetes. However, enrolling and retaining participants is a challenge for program providers. This evaluation aimed to understand factors that influence racial and ethnic minority groups in Hawai'i to enroll in and complete the program. From 2018 through 2023, two federally qualified health centers (FQHCs) in rural Hawai'i administered 6 year-long cohorts. Trained lifestyle coaches, who were FQHC staff members, recruited participants and facilitated the evidence-based curriculum. In 2023, the evaluation team conducted semistructured interviews with 14 of the 40 enrolled participants (35%), all of whom were women aged 25 to 74 years. Six participants identified as Native Hawaiian or Other Pacific Islander and 3 as Filipino. Eight participants reported completing the program. We used qualitative methodology to analyze transcripts. We identified themes around motivators, barriers, facilitators, and suggestions for improvement. Recruitment by trusted individuals in their communities motivated participants to enroll. Caregiving and work obligations were attendance barriers for early withdrawers and graduates. Social support from lifestyle coaches and enrolled friends and family were facilitators for program completion. Suggestions included improving class availability and incorporating culturally relevant recipes. Barriers experienced by Native Hawaiian or Other Pacific Islander and Filipino participants were similar to those reported by racial and ethnic groups in other studies. Program providers in rural communities should use trusted individuals as lifestyle coaches and recruit family and friends, regardless of National DPP LCP eligibility, to reduce caregiving barriers and engage critical support systems to facilitate completion.

Adapting Group Prenatal Care for Telehealth: A COVID-Era Innovation to Address Barriers to Care for Latinx Clients.

The use of telehealth prenatal care increased exponentially during the coronavirus disease 2019 (COVID-19) pandemic, but there is no literature describing its use for group prenatal care during this time. The COVID-19 pandemic also exacerbated structural barriers to care that disproportionately affect Black and Latinx people. Telehealth enabled pregnant people to access health care and minimize infectious risks. Telehealth group prenatal care (T-GPNC) incorporated the essential elements of CenteringPregnancy with telehealth is an innovative care delivery method borne out of necessity during the COVID-19 pandemic that has potential to mitigate structural barriers to care. Mary's Center is a federally qualified health center (FQHC) in Washington, DC, and Maryland that rapidly pivoted to individual telehealth prenatal care early in the pandemic. Mary's Center used our experience with group care and guidance from the Centering Healthcare Institute on virtual Centering to launch T-GPNC. This new model included home self-monitoring equipment and video classrooms, mixed with in-person individual care visits. We used a team-based approach with nurses, midwives, and community health workers to provide holistic care to pregnant people. Our robust care coordination team also connected them to home visiting, mental health services, and nutrition counseling. The purpose of this article is to describe how Mary's Center modified the CenteringPregnancy model of group prenatal care for telehealth, following the hallmarks of CenteringPregnancy, and met the needs of Spanish-speaking clients, henceforth Latinx clients. A secondary purpose is to demonstrate how telehealth can expand access to health care and remove structural barriers that may prevent pregnant people from attending in-person appointments. We also discuss the structural inequities in digital access and literacy in the context of program implementation.

A qualitative exploration of the implementation facilitators and challenges of a community health worker program to address health disparities for people recently released from incarceration using the consolidated framework for implementation research

BackgroundDespite the potential for community health worker (CHW)-led programs to improve the health of people with justice involvement (PWJI), little is known about the practical implementation of such models. We explored barriers and facilitators to implementation of a municipal CHW program, the Health Justice Network (NYC HJN), led by the New York City Department of Health and Mental Hygiene (DOHMH) in partnership with three reentry-focused community-based organizations (CBOs) and three federally qualified health centers (FQHCs) that was designed to serve the health and social service needs of PWJI.MethodsEighteen in-depth qualitative interviews were conducted with a purposive sample of CHWs, partner site supervisors, and DOHMH staff. Interviews were conducted virtually and transcribed verbatim. Codes and themes were developed using the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers to NYC HJN implementation.ResultsImportant facilitators to implementation included: lived experience of CHWs, as well as NYC HJN’s voluntary nature, lack of onerous eligibility criteria, and prioritization of participant needs. One barrier was the lack of a formal implementation protocol. Themes identified as facilitators in some instances and barriers in others were CHW integration into site partners, the expansive scope of work for CHWs, the integration of a trauma-informed approach, values alignment and existing infrastructure, leadership engagement, CHW training and support, and input, feedback, and communication.ConclusionsFindings will help inform how to successfully implement future CHW-led interventions for PWJI with municipal, health, and social service partners.

Leadership in federally qualified health centers: examining recruitment and retention in rural Oklahoma.

Healthcare workforce shortages, particularly in rural areas, present a global challenge. The purpose of this study is to explore the leadership dynamics within federally qualified health centers (FQHC) in rural Oklahoma, focusing on recruitment, retention, job satisfaction and development practices. Eighteen managers with five or more years of tenure from Oklahoma FQHCs were interviewed. Leadership's role in influencing job satisfaction, recruitment, retention and development practices was analyzed using a multilevel ecological framework through qualitative content analysis with NVivo. The analysis includes ten key themes including the critical role of leadership in addressing recruitment and retention challenges, the importance of aligning organizational culture, rural culture, access challenges, trainings and values with workforce development initiatives, and the impact of leadership practices on job satisfaction. This study uniquely examines leadership strategies in rural FQHCs, integrating ecological considerations for cultural, logistical and community-specific factors. It emphasizes the pivotal role leadership plays in shaping workforce development. As rural healthcare evolves, refining these approaches is crucial for addressing workforce challenges, improving healthcare access and ensuring that rural FQHCs remain sustainable, driving positive outcomes for healthcare professionals and communities.

8642 Continuous glucose monitor: reclaiming type 2 diabetes self-efficacy and mitigating disparities

Abstract Disclosure: K. Ni: None. C.A. Tampe: None. K. Sol: Employee; Self; Patient accepted job with Dexcom Jan 2024. L. Cervantes: None. R.I. Pereira: None. Context: The increase in continuous glucose monitor (CGM) use has been notable for widening disparities between the least and most socially marginalized. Given access barriers, there is limited CGM patient experience information that is inclusive of those with type 2 diabetes mellitus from socially marginalized backgrounds. Objective: To understand the CGM usage experience across a U.S. Medicaid population with type 2 diabetes at federally qualified health centers (FQHCs). Methods: This qualitative study used semi-structured phone interviews with 28 English or Spanish speaking participants prescribed CGM who were enrolled in a U.S. Medicaid program that subsidized CGM. Audio-recordings of interviews were transcribed and analyzed by inductive thematic analysis. Results: Participants had a median age 56 (interquartile range 48-60) with varying levels of formal schooling (55% with 9 years or less) and were from diverse racial or ethnic backgrounds (57% Hispanic, 18% non-Hispanic Black, 21% non-Hispanic White). Interviews were conducted in English (68%) or Spanish (32%). We identified six major themes: initial expectations and overcoming initiation barriers (subthemes: initial expectations, overcoming initiation barriers), convenience and ease promote daily use (subthemes: benefits over fingersticks), increased knowledge leads to improved self-management (subthemes: increased understanding and knowledge, glucose level self-awareness, motivating healthy behaviors), collaboration with provider and clinical team, improved self-reported outcomes (subthemes: improved glucose and non-glucose targets, positive emotional effect, essential for management), and barriers and burdens are generally tolerated (subthemes: barriers to monitoring, burden of self-monitoring). Conclusions: CGM was experienced as easy to understand and use and viewed as a tool for diabetes self-efficacy. Expanded CGM access for socially marginalized patients with type 2 diabetes can enhance diabetes self-management to help mitigate diabetes outcome disparities. Presentation: 6/2/2024

340B Participation and Safety Net Engagement Among Federally Qualified Health Centers

The 340B program provides discounts on outpatient drugs to certain hospitals and federally supported clinics (covered entities) that can be used to generate revenue to fund safety net care. While numerous studies have found no association between 340B and safety net care provision for most hospital covered entities, less is known about whether federally qualified health centers (FQHCs), the largest group of covered entities after hospitals, use the program to enhance safety net care. To assess whether a proxy for 340B revenue was associated with increased safety net care provision among FQHCs. This descriptive, retrospective cohort study examined care provided from 2005 to 2022 by 1468 FQHCs that submitted to the Health Resources and Services Administration Uniform Data System. FQHC and year-level fixed effects were included, as well as a control for differential Medicaid expansion over time. The data were analyzed between March and December 2023. One-year lagged number of locations registered to dispense or administer 340B-discounted drugs (registered locations), which included child sites, in-house pharmacies, and contract pharmacies in the 340B Outpatient Pharmacy Affairs Database. Natural logarithm of patient volume by payer, low-income status, and use of enabling services. Natural logarithm of visits in which low-profit preventive services were provided. An additional registered location was associated with increased patient volume, especially for uninsured (0.4%; 95% CI, 0.3%-0.5%) and privately insured (0.4%; 95% CI, 0.2%-0.5%) patients and low-income (0.4%; 95% CI, 0.2%-0.6%), unhoused (0.3%; 95% CI, 0.1%-0.5%), and non-English-speaking (0.3%; 95% CI, 0.1%-0.5%) patients. An additional registered location was associated with increased visits with an HIV test (0.7%; 95% CI, 0.4%-0.9%), serum lead test (0.8%; 95% CI, 0.6%-1.1%), seasonal influenza shot (0.4%; 95% CI, 0.3%-0.5%), Papanicolaou smear (0.5%; 95% CI, 0.4%-0.7%), and tobacco cessation counseling (1.0%; 95% CI, 0.5%-1.4%). Across the study period, the average annual increase in locations was 1.5. The results of this cohort study suggest that there are statistically significant increases in the provision of low-profit but high-value preventive services and care to safety net populations (those who lack insurance, have a low income, or require enabling services) and that, like public hospitals, FQHCs might use 340B revenues to enhance safety net care. This finding may inform debates on the 340B program by supporting differential 340B reforms across hospital and nonhospital covered entities.

Early Health Impacts of a Primary Care Consultation Model for People Served by Assertive Community Treatment teams.

The cardiometabolic health outcomes and life expectancy of people living with serious mental illness (SMI) continue to significantly flag behind that of the general population. This study explores the possibility of using the evidence-based Assertive Community Treatment (ACT) model and infrastructure to increase access to primary care and improve cardiometabolic outcomes of people with SMI. Four ACT teams in a large urban area received the services of a primary care consultant who was co-located at a Federally Qualified Health Center (FQHC), met regularly with ACT team clinicians to review a cardiometabolic registry of participants, and engaged participants in primary care services. Health screening rates, primary care utilization, and cardiometabolic outcomes-body mass index, blood pressure, hemoglobin A1c, cholesterol, and tobacco smoking status-were monitored over the course of a year. The efficacy of this integrated care model was also explored through focus groups with ACT team staff and participants. Significant improvements in screening rates were found for the ACT teams that received this integrated care intervention; however, only modest improvements in cardiometabolic outcomes were found. Future longitudinal, multi-site studies are needed to fully determine the impact of integrated care models on the physical health outcomes of this vulnerable population.

A Quality Improvement Approach to Increasing Access to long-Acting Reversible Contraceptives in a Federally Qualified Health Center.

Long-acting reversible contraceptives (LARCs) are the most effective forms of contraception available and therefore play a critical role in supporting patients to exercise bodily autonomy and achieve reproductive goals. A comprehensive set of quality improvement (QI) interventions were implemented between March and June 2019 to improve LARC access at a federally qualified health center (FQHC) in (US State). An evaluation study was conducted to assess the impact of the QI initiative considering the number of LARCS delivered as a proxy for access. The Wilcoxon-rank test was applied to test for significance, given a non-parametric sample of LARCs delivered by 13 providers (matched to themselves) pre- and post-intervention. Reimbursement for LARC procedures pre- and post-intervention was also examined to determine economic impact and sustainability of incorporating a new device, the Liletta™, in the floor stock. There was a statistically significant increase in LARC delivery between July 2019-March 2020 compared to July 2018-March 2019. Approximately $1,000 per month increased reimbursement for LARC services occurred post-intervention. The evaluation study concluded success of the QI intervention, with need for further study needed to determine equitable delivery of contraceptive services between different subpopulations and by insurance status. The study provides a blueprint for QI initiatives to improve access to LARCs while also increasing revenue for LARC services in an FQHC setting.

Assessing capacity for hereditary cancer risk assessment in metro Chicago.

307 Background: Since 2005, the United States Preventive Services Task Force (USPSTF) recommends that primary care (PC) clinicians identify and refer adults with a high-risk cancer family history to cancer genetic services (CGS), yet hereditary cancer risk assessment (HCRA) continues to be underutilized in PC. A population-based approach to HCRA in PC settings can expand access to cancer prevention and early detection to vulnerable populations and reduce disparities in cancer outcomes. The Chicago Cancer Screening and Testing Access Coalition (CCSTAC) is developing strategies to integrate HCRA in PC settings. We conducted an environmental scan to assess current capacity to deliver 1) HRCA in Federally Qualified Health Centers (FQHCs) and 2) follow-up CGS for high risk patients. Methods: In 2023, we administered two surveys to assess HCRA practices in Metro Chicago. We invited 22 FQHCs to complete a 21-item survey of current practices, readiness to implement, and barriers to HCRA. We also invited 21 CGS sites to complete a 25-item survey to understand staffing, utilization, referral patterns, and barriers to access. Surveys were administered electronically via Qualtrics. We conducted a descriptive analysis of survey data. Results: Twenty FQHCs (91%) completed the survey on HCRA in PC; 85% reported familiarity with USPSTF guidelines for HCRA. The majority (75%) reported no plans to implement HCRA. Clinic workflow, paucity of follow-up resources, cost, lack of provider knowledge, and absence of HCRA as a mandatory performance measure were cited as the most significant barriers to implementation. Genetic counselors (GCs) from 19 CGS hospital-based sites (90%) completed the survey on availability of genetic services. CGS were most often located in a cancer center (47%); no CGS were located in PC. Most referrals originated from oncology, surgery, or gastroenterology, with the lowest rate of referrals from community-based PC. Nearly half of CGS clinics (47%) reported capacity for at least a small increase in patient volume. Wait-time at the majority of CGS clinics was less than a month. GCs cited patient logistics (e.g. transportation, time off work), lack of referral information from providers, and systemic racism as significant barriers in patient access to CGS. Conclusions: After almost 20 years of evidence-based guidelines, use of HCRA is still very limited in the community-based PC setting. Our findings point to a need to bridge the gap between hospital-based CGS and FQHCs to ensure patients in vulnerable communities have access to guideline-concordant cancer prevention and screening strategies. Based on these findings, CCSTAC is designing strategies to integrate HCRA in primary care at FQHCs focused on provider education, well-designed clinic workflows, connections with existing CGS, and advocacy to align UDS and HEDIS measures with USPSTF guidelines.

Leveraging a geographic information system (GIS) to identify lung cancer care disparities and opportunities in rural Appalachia.

78 Background: The Rural Appalachian Lung Cancer Screening Initiative is led by the Association of Cancer Care Centers (ACCC) and patient advocacy partners. Recognized by the White House Cancer Moonshot, this initiative seeks to improve lung cancer screening rates by partnering with health systems in rural Appalachia to develop and implement interventions. An 11-county region bordering West Virginia, Virginia, and Kentucky has significantly higher mortality and lung cancer incidence rates than the national rates of 35.0 and 54.0 per 100,000 people, respectively (Table 1). This region was identified as the focus area for the initiative with participation from health systems in Pike County, KY, and Buchanan County, VA. Methods: To understand availability of local resources, ACCC developed an interactive GIS tool that identifies screening and referral locations as well as essential services in the region. Lung cancer screening sites, oncology services, mammography locations, critical access hospitals, NCI-designated cancer centers, federally qualified health centers (FQHCs) and look-alikes, rural health clinics, and primary care/general health services were identified from publicly available data and data requested from state departments of health. Facilities were contacted to verify services when unclear. STATA 18 was used to combine and clean data for upload to Google MyMaps, creating an interactive map. Results: Of the 11 counties, all contain at least 1 FQHC or primary care site. However, 5 of the counties do not have lung cancer screening sites and 7 of the counties do not have oncology service sites (Table). The closest NCI-designated cancer centers to the participating sites are over 140 miles away. Conclusions: While there is a notable presence of primary care, access to lung cancer screening and oncology care is limited. Sites can utilize this map to inform development of interventions by considering potential geographical challenges, identifying referral sites, outreach opportunities, and partners to facilitate lung cancer screening and education. Further, these methods are replicable, and can be used to inform current access to care and improve equitable delivery of lung cancer screening in regions across the U.S. Distribution of lung cancer mortality, incidence, and infrastructure within initiative focus region. Region Mortality*(per 100,000) Incidence*(per 100,000) # Lung Cancer Screening Sites # Oncology Services Sites KY (1 county) 70 109.3 2 2 VA (6 counties) 45.0 – 61.4 42.9 – 68.6 4 3 WV (4 counties) 57.6 – 74.8 100.4 – 111.5 1 0 *Lung &amp; Bronchus, 2016-2020 age-adjusted death rates (KY, VA, WV) and incidence rates (KY, WV). Lung &amp; Bronchus, 2015-2019 age-adjusted incidence rate (VA). Source: statecancerprofiles.cancer.gov.

A Proactive Telephonic Outreach Program to Address Unmet Social Needs of Children in Immigrant and Refugee Families at a Federally Qualified Health Center.

We developed a telephonic outreach and care coordination program for children in immigrant and refugee families (CIRF) at a federally qualified health center (FQHC) in North Carolina to address unmet health-related social needs (HRSN). Participants were recruited between December 2020 and October 2021. Eligible children were ages 0-5, non-English speaking, and were seen at the FQHC in the 2years prior. A bicultural/bilingual case manager completed telephonic outreach to caregivers of participants with HRSN screening. Bilingual patient navigators made follow-up calls to assess connection to resources and to develop strategies for addressing unmet needs. Three hundred forty-two families received outreach; 212 (62.0%) completed the baseline questionnaire. The majority (N = 160, 75.5%) completed at least one follow-up. The majority (N = 186, 88.1%) were Spanish-speaking, and over two-thirds (N = 149, 70.3%) were uninsured. Most participants had between 3-5 HRSNs identified (N = 121, 57.1%); "employment" (n = 158, 74.5%) and "food" (n = 138, 65.1%) were the most common. Despite repeated assistance, the majority of participants struggled to link to a community resource for their highest priority need (N = 123, 78.3%). Proactive phone-based HRSN screening may be a feasible and effective intervention to facilitate the identification of social needs for CIRF. The delivery of the intervention in languages other than English may have further contributed to program acceptability. Despite program feasibility and acceptability, community-level barriers to the resolution of HRSNs persist. While similar care coordination models can be considered to identify the high burden of unmet HRSN among CIRF, addressing the limited capacity of community-based resources for this population will be a critical component to ensuring the sustainability of such programs.

The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing.

Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a "think aloud" exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website's acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website's content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool's usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs.

Abstract B044: Assessing Native Americans’ readiness for lung cancer screening and smoking cessation

Abstract Introduction: Among all U.S. racial/ethnic populations, Native Americans (American Indians) experience the highest rates of commercial tobacco use and lung cancer incidence and mortality. The goal of the Native American Commercial Tobacco and lung cancer screening InterventiON Study (NACTIONS) is to address these disparities by measurably increasing lung cancer screening (LCS) in the context of smoking cessation. Building off a history of collaborations, the University of California, Davis (UCD) reached out to two Native-serving Federally Qualified Health Centers (FQHCs) in its catchment area to co-design means to improve lung health among their Native patients. Methods: In recognition of the extra time and effort involved, the UCD offered modest funding to these two FQHCs in inland northern California as well as gift cards for providers in sharing their practices in offering smoking cessation and LCS as well as interviews with their Native patients. Eligibility criteria for LCS were based on the 2021 US Preventive Services Task Force Recommendations that specified age: 50-80 years old and smoking history of 20 pack years for current smokers or those who quit within the past 15 years. We interviewed 14 providers and two categories of Native patients: both who had completed LCS (n=9) and those who are eligible but had not yet been screened (n=8) to understand facilitators, barriers, and solutions. A Native leader provided us with a conceptual framework to understand Native resiliency in addressing addiction to guide our approach. We also convened monthly meetings to discuss observations and co-design next steps. Findings: Both FQHCs reported approximately 400 Native patients eligible for LCS, but the readiness levels for interventions to promote smoking cessation and LCS were not the same. Each FQHC is under-resourced and each FQHC’s electronic medical system was not originally formulated for research. However, IT directors were willing to increase their scope to document patients’ readiness for intervention and their smoking histories through the LCS process. Common to both FQHCs is the essentiality of earned trust with their patients; adapting each FQHC’s electronic health system for precisely identifying eligible patients and longitudinally following them; assessing their social determinants of health; and the need to provide lung health education for the entire community. For instance, the high prevalence of diabetes, substance abuse, homelessness, etc. must be considered and the need to have tribal, friends, and family support for lung health can be reinforced through community-wide health education and patient navigation. Conclusions: This needs assessment documented factors that will enhance efforts for promoting LCS and smoking cessation at two Native-serving FQHCs. Promoting lung health through smoking cessation and increased completions of LCS can be better achieved through collaboration, addressing both social and physiological determinants of health, and earned trust. Citation Format: Julie Dang, Mayra Sandoval, David Cooke, Miriam Nuno, Carla Martin, Bobbi Jo Simmons, Teresa Martens, Elisa Tong, Moon S. Chen Jr. Assessing Native Americans’ readiness for lung cancer screening and smoking cessation [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B044.

Abstract A130: Examining breast cancer screening completion: Comparing patient self-report and electronic health record data at a Federally Qualified Health Center during the SARS-CoV-2 pandemic

Abstract Intro: There is evidence to suggest that preventive services, such as breast cancer screening, were impacted during the SARS-CoV-2 pandemic with interruption in screening mammogram services during March-July 2020. Federally Qualified Health Centers (FQHCs) are a critical health system to help better understand pandemic sequelae among diverse patient populations so teams can better prepare for a future pandemic. US Preventive Services Task Force (USPSTF) recommends average-risk patients aged 50-74 screen for breast cancer biyearly. Based on USPSTF recommendations in 2021, 76% of non-Hispanic White women and 74 % of Latina women were up-to-date on mammography screening. Our study, RESTORE, focuses on understanding patient barriers and facilitators to completing breast cancer screening at one large urban FQHC during the pandemic. Here, we compare FQHC patient self-reported completion of breast cancer screening to documented breast cancer screening found in the electric health record (EHR). Methods: Patients (n=20) were interviewed between July 2023 and February 2024 about their healthcare utilization, breast cancer screening (including medical site), and health literacy throughout the COVID period (2018-2022). When a screening date was documented in the EHR, interviewers mentioned the screening date to participants during the interview. Interviews were audio recorded and transcribed. A preliminary review of these interviews was conducted to collect self-reported breast cancer screening date and compare it to the date in the EHR. Results: Interviewees’ average age was 65.1 years; 70 % were Spanish-speaking; 60% were Latino, and 95% were female. Of the Spanish-speakers, 8 out of 14 patients self-reported completing a mammogram between 2018-2022, with 2 of 8 reporting having completed it with an onsite vendor. Only 3 of these 8 mammograms were captured in the EHR. Of these three, 2 patients were prompted with the EHR date during the interview: one patient agreed with the date while the other rejected the date. Among the English-speaking patients, 4 out of 6 patients self-reported completing a mammogram between years 2018-2022, all of these 4 self-reported dates were captured in the EHR. Of these 4 patients, all were prompted with the EHR date, 3 agreed to the date and one rejected the date, with 3 of 4 reporting having completed it with an onsite vendor.Conclusion: Throughout COVID, FQHC patients sought mammogram screening; however, gaps in data systems limited completeness of the health system’s mammogram EHR data. Time delays between patient experience and interview dates, complicated our understanding of patients’ COVID experiences. The inconsistency between self-reported dates and EHR dates also creates challenges educating and convincing patients to stay up-to-date on screenings based on recommended intervals. Missing EHR data could have also impacted staff not accurately following-up for mammograms or referrals. Additional work is needed to understand the opportunities to better integrate FQHC EHR with mammogram vendor data systems. Citation Format: Anne Escaron, Crystal Gomez, Jennifer Schneider, Jennifer Rivelli, Fabian Hidalgo, Gloria Coronado. Examining breast cancer screening completion: Comparing patient self-report and electronic health record data at a Federally Qualified Health Center during the SARS-CoV-2 pandemic [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A130.

Abstract A141: Exploring patient barriers and facilitators to colorectal cancer screening during the SARS-CoV-2 pandemic

Abstract Intro While there has been a national initiative to achieve 80% colorectal cancer (CRC) screening rates, not all population subgroups reach this target. Specifically, Latino populations have shown lower CRC screening rates compared to non-Latino White populations. Furthermore, the SARS-CoV-2 pandemic led to a decline in CRC screening uptake, particularly in Federally Qualified Health Centers (FQHCs). One large, urban FQHC, primarily serving Latino patients, has invested in stool-based, home-mailed CRC screening outreach. This FQHC serves as the site for the RESTORE study. Here, we describe patient-level barriers and facilitators to home fecal immunochemical test (FIT) screening throughout the COVID-19 pandemic. Methods Patients (n=15) were interviewed between August 2022 and May 2023. Interviews addressed health care utilization and CRC screening throughout the COVID-19 pandemic. Patient interviews were audio recorded and transcribed. A preliminary review of these interviews was conducted to assess patients’ use of telehealth as well as patients’ self-reported FIT completion. Results Participants’ average age was 58.5 years old; 53% identify as female; 66% report Spanish as their preferred language; and 80% identify as Latino. Ten patients (6 Spanish-speaking and 4 English-speaking) reported completing a home-mailed screening test. Among them, four emphasized the convenience of completing their CRC screening at home and found it beneficial to have wordless instructions included in their mailed FIT to guide them through the process. While these patients were able to complete their FIT, 3 reported that they never received their result. Of note, one of the Spanish speakers postponed FIT completion until in-person care resumed. Of the 4 Spanish-speaking patients who did not complete a FIT: 2 completed a colonoscopy, while the other 2 disposed of their FIT. The lone English speaker who did not complete FIT cited a fear of cancer as a barrier to screening. Patients who completed a colonoscopy described the procedure as easy; however, one patient experienced complications post-procedure. Telehealth visits were utilized by 80% of patients in 2020 and 73% in 2021, covering various health topics such as COVID-19 symptoms, infection, medication refills, and exam referral and results, with some patients citing convenience and quicker access to providers. Conclusions Throughout the SARS-CoV-2 period, patients continued to benefit from the FQHC’s mailed FIT outreach. As a novel primary care modality, patients reported completing clinical encounters via telehealth during the COVID-19 pandemic to discuss a range of health topics with a provider. To improve preparedness for future natural disasters, it is imperative to understand FQHC patients’ CRC screening experiences during this dynamic period. Citation Format: Anne Escaron, Robert Lara, Karina Ramirez, Adolfo Jacobo, Jennifer Schneider, Jennifer Rivelli, Crystal Gomez, Alexis Perez, Gloria Coronado. Exploring patient barriers and facilitators to colorectal cancer screening during the SARS-CoV-2 pandemic [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A141.

Abstract C132: Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles

Abstract Introduction: Multilevel barriers to screening and follow-up contribute to persistent disparities in cervical cancer burden, particularly in marginalized communities receiving care in safety-net healthcare settings. While evidence-based interventions (EBIs) exist for improving cancer screening and follow-up, building capacity to identify effective strategies for implementation and alignment of EBIs to the context of safety-net settings and the diverse communities they serve is critical. Methods: Supported by the HRSA Accelerating Cancer Screening Program, Chinatown Service Center, a multi-site Federally Qualified Health Center (FQHC) serving Chinese and Latino/a populations in Los Angeles, and USC Norris Comprehensive Cancer Center established a new partnership to identify multilevel factors that impact cervical cancer screening, follow-up and referral and inform the implementation of EBIs to improve care. We conducted a mixed methods assessment June-December 2023 to understand care processes through surveys and qualitative interviews (20-30 minutes, guided by the Consolidated Framework for Implementation Research) with providers and clinic staff and medical chart reviews of patients with ≥ 1 cervical cancer screening order January 2020-March 2023. Results: Surveys (n=23) showed higher knowledge of screening guidelines (p&amp;lt;0.05) and more confidence discussing cervical cancer with patients (p&amp;lt;0.05) among providers compared to clinic staff, indicating opportunities for staff training. Qualitative interviews (n=23) identified inner setting barriers such as limited system-level implementation of cervical cancer screening guidelines and limited technology supports to track patients requiring follow-up. At the individual level, older patients and those not sexually active often declined testing and requested gender concordant (female) providers. Motivation for building cervical cancer care capacity within the FQHC were noted, with clinic members highlighting FQHC strengths in addressing cultural barriers, social needs, and community outreach. Several outer setting barriers emerged for referral and follow-up care, including long wait times for referrals, trouble finding language concordant specialists, transportation barriers, and difficulty accessing specialists through their managed care network. Medical chart abstractions (n=1,428) identified opportunities to improve closed-loop communication with specialists and limited ease for clinic staff identify high and low risk screening results for further treatment. Discussion: By establishing a new FQHC-NCI cancer center partnership, we advanced our combined capacity to address cervical cancer care equity in marginalized communities. We identified patient-level (cultural, logistic, social determinants), provider/clinic staff-level (training needs, patient tracking), and system-level (access to and communication with specialists) barriers that will require selection of EBIs and implementation strategies via a partnered approach with local specialists, health systems, payers, and policymakers. Citation Format: Jennifer Tsui, Samantha Garcia, Emily Dang, Alejandra Ramos, Allison Oh, Kathy Lui, Angela Ching, Eugene Hui, Chanita Hughes Halbert, Lourdes Baezconde-Garbanati, Jack Cheng. Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C132.