Urban Federally Qualified Health Centers Research Articles

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.

Metered-Dose Inhaler Versus Nebulizer Treatment for Acute Asthma Exacerbation: A Process Evaluation.

Background: The prevalence of childhood asthma in the United States is 6.5%. During the COVID-19 pandemic, a Federally Qualified Health Center (FQHC) implemented metered-dose inhalers (MDIs) with spacers instead of nebulized albuterol to reduce aerosolization of pathogens and reduce costs. Objective: The objective of the study is to assess the safety, efficacy, and efficiency of a change to the asthma exacerbation protocol at an urban FQHC. Methods: A retrospective chart review compared nebulized albuterol versus an MDI with a spacer in pediatric patients experiencing asthma exacerbation. The evaluation aimed to measure (a) the 30-day return to care in either the emergency department (ED) or clinic, (b) the total number of treatments administered, and (c) the documented use of an oral steroid with albuterol treatments. Results: Return to clinic was the only statistically significant variable. Zero MDI patients returned, whereas 61% of those nebulized returned within 30 days (p < .00001). Conclusions: Albuterol MDI with a spacer was more effective than a nebulizer in reducing follow-up visits to the clinic and was effective at reducing ED visits within 30 days. Implications for Nursing: Treating asthma exacerbations in the primary care clinic with an MDI is effective and reduces cost and airborne exposure.

Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction

BackgroundBurnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members.ObjectiveExamine associations of provider burnout with their perspectives on quality improvement (QI), patient experience measurement, clinic culture, and job satisfaction.DesignWe conducted a cross-sectional provider survey about their perspectives including the single-item burnout measure. We fit separate regression models, controlling for provider type, gender, being multilingual, and fixed effects for clinic predicting outcome measures from burnout.ParticipantsSeventy-four providers from 44 clinics in large, urban FQHC (52% response rate; n = 174).Main MeasuresSurvey included a single-item, self-defined burnout measure adapted from the Physician Worklife Survey, and measures from the RAND AMA Study survey, Heath Tracking Physician survey, TransforMed Clinician and Staff Questionnaire, Physician Worklife Survey, Minimizing Errors Maximizing Outcomes survey, and surveys by Friedberg et al. 31 and Walling et al. 32ResultsThirty percent of providers reported burnout. Providers in clinics with more facilitative leadership reported not being burned out (compared to those reporting burnout; p-values < 0.05). More pressures related to patient care and lower job satisfaction were associated with burnout (p-values < 0.05).ConclusionsCreating provider-team relationships and environments where providers have the time and space necessary to discuss changes to improve care, ideas are shared, leadership supports QI, and QI is monitored and discussed were related to not being burned out. Reducing time pressures and improving support needed for providers to address the high-need levels of FQHC patients can also decrease burnout. Such leadership and support to improving care may be a separate protective factor against burnout. Research is needed to further examine which aspects of leadership drive down burnout and increase provider involvement in change efforts and improving care.

Improving Guideline-Recommended Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC): Implementing a Patient Navigation and Practice Facilitation Intervention to Promote Health Equity.

Colorectal cancer (CRC) screening is effective in the prevention and early detection of cancer. Implementing evidence-based screening guidelines remains a challenge, especially in Federally Qualified Health Centers (FQHCs), where current rates (43%) are lower than national goals (80%), and even lower in populations with limited English proficiency (LEP) who experience increased barriers to care related to systemic inequities. This quality improvement (QI) initiative began in 2016, focused on utilizing patient navigation and practice facilitation to addressing systemic inequities and barriers to care to increase CRC screening rates at an urban FQHC, with two clinical locations (the intervention and control sites) serving a diverse population through culturally tailored education and navigation. Between August 2016 and December 2018, CRC screening rates increased significantly from 31% to 59% at the intervention site (p < 0.001), with the most notable change in patients with LEP. Since 2018 through December 2022, navigation and practice facilitation expanded to all clinics, and the overall CRC screening rates continued to increase from 43% to 50%, demonstrating the effectiveness of patient navigation to address systemic inequities. This multilevel intervention addressed structural inequities and barriers to care by implementing evidence-based guidelines into practice, and combining patient navigation and practice facilitation to successfully increase the CRC screening rates at this FQHC.

"We want to be heard": A Qualitative Study of Mental Health Care Access among Patients of an Urban Federally Qualified Health Center.

Although depression is common in primary care, challenges to timely intervention exist, particularly for communities of color and lower socioeconomic status. Our objective was to understand barriers and facilitators to mental healthcare access among a sample of patients receiving care at a federally qualified health center (FQHC) in Minnesota, United States. We qualitatively interviewed 34 patients of an urban FQHC, purposively sampled on race/ethnicity, insurance status, language, and depression symptom status (based on Patient Health Questionnaire-9 responses). We inductively and deductively analyzed interview data, leveraging theory in both the codebook development and analysis processes. Participants, who were predominantly English-speaking, female, not privately insured, and people of color, shared numerous barriers and facilitators to accessing mental healthcare. Prominent barriers primarily concerned healthcare providers, including perceived dismissal of mental health concerns and challenges with provider continuity. Additional barriers included the costs of mental health care, communication breakdowns, the patient portal, and community-specific perceptions of mental health. Prominent facilitators included clinic organizational factors (internal and external) and staff friendliness and warmth. Other factors including consideration of patients' financial situation, integrated management of behavioral and physical health conditions, language concordant staff, the telehealth visit modality, and the clinic's social mission were also raised as facilitating access. Patient voices from a single FQHC illustrate the challenges and possibilities of providing mental healthcare in safety net settings. Clinical, strategy, and policy solutions can be tailored to minimize barriers and optimize facilitators documented herein.

Implementing an enhanced mailed FIT program to improve CRC screening at a federally qualified health center: experiences of patients and staff.

Colorectal cancer (CRC) is a leading cause of cancer death in the USA. Screening programs in federally qualified health centers (FQHCs) are essential to reducing CRC-related mortality and morbidity among underserved populations. Centralized, population-based mailed fecal immunochemical test (FIT) programs can improve CRC screening rates, but barriers to implementation remain. We qualitatively explored barriers and facilitators to implementation of a mailed FIT program at a large, urban FQHC that employed advance notification "primers" (live calls and texts) and automated reminders. We interviewed 25 patients and 45 FQHC staff by telephone about their experience with the program. Interviews were transcribed, coded, and content analyzed using NVivo.12. Patients and staff found advance notifications conveyed through live phone calls or text messages to be acceptable and motivational for FIT completion. Live phone primers were helpful in addressing patients' questions and misconceptions about screening, particularly for patients new to screening. Advance notifications sent by text were considered timely and useful in preparing patients for receipt of the FIT. Barriers to implementation included lack of receipt of primers, reminders, or the mailed FIT itself due to inaccurate patient contact information within the FQHC medical record; lack of systems for documenting mailed FIT outreach to coordinate with clinical care; and lack of local caller identification for primers and reminders. Our findings demonstrate that an enhanced mailed FIT program using primers and reminders was acceptable. Our findings can help other FQHCs implement and optimize their mailed FIT programs.

S253 Colorectal Cancer Screening Rates at Federally Qualified Health Centers in 2019 and 2020 Varied Based on Urban-Rural Status and Predominant Racial/Ethnic Group

Introduction: Over 30 million low-income and underinsured individuals in the U.S. receive primary care services, including colorectal cancer (CRC) screening, at Federally Qualified Health Centers (FQHCs). Given known differences in healthcare access in rural settings, we aimed to quantify CRC screening rates and factors associated with a decline in screening between 2019 and 2020 at FQHCs based on urban-rural status. Methods: We abstracted data from the Uniform Data System (UDS)—which compiles preventive health utilization data, including CRC screening rates among patients ages 50-74—for each FQHC. Our primary outcome was screening rate change (SRC), calculated as 2020 CRC screening rate minus 2019 CRC screening rate. We separated FQHCs based on urban-rural status and then created quartiles based on SRC. We used Wilcoxon Rank-Sum and x2 testing to compare rural and urban FQHCs and performed backward stepwise multivariable logistic regression to determine FQHC-level characteristics (2020 data) associated the largest decline in screening participation between 2019 and 2020 (SRC Q1 status). Results: In 2020, 734 urban and 527 rural FQHCs served 6,438,433 patients who were age-eligible for CRC screening. FQHC characteristics were significantly different between urban and rural FQHCs (Table). CRC screening rates were lower in rural FQHCs than urban FQHCs in 2019 (p=0.04) and 2020 (p< 0.0001), and SRC was lower in urban (-3.6%) than rural (-1.2%) FQHCs (p< 0.0001) (Table). Urban FQHCs were more likely to see a decline in CRC screening in 2020 if they served a majority non-Hispanic Black patients (aOR 2.05, 95%CI=1.19-3.52) or if they served a high proportion of uninsured patients (data not shown). Rural FQHCs were more likely to see a decline in CRC screening in 2020 if they served a majority Hispanic/Latinx patients (aOR 2.78, 95% CI=1.50-5.15) or if they were in a non-Medicaid expansion state (aOR 1.81, 95% CI 1.09-2.99) (data not shown). SRC was calculated by state for rural FQHCs and mapped in the Figure. Conclusion: Urban FQHCs had a greater decline in CRC screening rates from 2019 to 2020 than rural FQHCs and experienced larger declines if the patient population was predominantly Black or uninsured. Rural FQHCs saw a steep decline if they served a majority Hispanic/Latinx population or were in a non-Medicaid expansion state. These findings suggest that efforts to increase CRC screening at US FQHCs may need to be tailored to their location, demographics, and insurance and Medicaid eligibility status.Figure 1.: Map of screening rate change (2020 CRC screening rate – 2019 CRC screening rate) by state for rural FQHCs and indication of Medicaid expansion status as of 2020 Table 1. - FQHC characteristics (2020 data), colorectal cancer (CRC) screening rates (2019 and 2020), and screening rate changes (SRC) for urban and rural FQHCs in the US overall and by SRC comparison groups All FQHCs (n=1261) Urban FQHCs (n=734) Rural FQHCs (n=527) p-value* Frequency or percent SRC Q1 (n=218) SRC Q2+Q3+Q4 (n=516) Total (n=734) SRC Q1 (n=98) SRC Q2+Q3+Q4 (n=429) Total (n=527) Total patients eligible for CRC screening (age 50-74) 6,438,433 1,328,330 2,811,734 4,140,064 483,110 1,815,259 2,298,369 n/a CRC screening rate in 2019 (median %) 42.9 48.0 38.3 41.6 48.5 43.7 44.7 0.04 CRC screening rate in 2020 (median %) 38.8 32.4 38.8 36.9 32.7 43.9 42.4 < 0.0001 Median 2019-2020 SRC -2.7 -13.7 -1.2 -3.6 -12.6 0.1 -1.2 < 0.0001 Male patients (median %) 42.9 42.1 42.3 42.2 43.4 43.9 43.8 < 0.0001 Majority Race/Ethnicity served at FQHC (median %) Non-Hispanic White 36.4 16.0 25.2 21.7 66.9 70.4 70.1 < 0.0001 Non-Hispanic Black 8.2 12.7 19.1 17.3 2.6 1.6 1.6 < 0.0001 Hispanic/Latinx 15.8 33.4 24.7 26.8 7.7 5.5 6.1 < 0.0001 Other Non-Hispanic 4.6 5.2 5.9 5.7 2.5 3.4 3.3 < 0.0001 Patients with a preference for non-English Language (median %) 11.7 27.1 17.9 19.2 6.7 3.5 3.8 < 0.0001 Patients experiencing homelessness (median %) 1.8 3.2 2.6 2.7 1.1 1.0 1.0 < 0.0001 Patients with income Level >200% FPL (median %) 4.6 2.9 3.8 3.5 6.5 8.1 7.8 < 0.0001 Uninsured patients (median %) 19.6 23.9 21.5 22.3 19.7 16.2 16.7 < 0.0001 Medicaid Expansion (%) 71.6 76.6 73.6 74.5 59.2 69.5 67.6 0.007 *p-values represent Wilcoxon rank-sum or chisq tests comparing overall characteristics between urban and rural FQHCs.

S317 Demographic Disparities in Colorectal Carcinoma Screening in a Large Urban Federally Qualified Health Center Network

Introduction: Epidemiologic studies continue to show disparities in CRC screening. Demographic factors including age, gender, race/ethnicity, level of education, and primary language affect the chance of having age-appropriate CRC screening. The endpoint of this study was to investigate potential differences in CRC screening by gender, race/ethnicity, and primary language in one of the largest Federally Qualified Health Center (FQHC) networks in the U.S. Methods: In this retrospective, observational study, data was obtained from the electronic medical records (EMR) of 12,663 patients aged 50-75 years old seen at Family Health Centers at NYU Langone during the period between August 2019 and July 2020. Results: CRC screening was done in n=4034 (56.6%) females, but only n=2531 (45.7%) males. In terms of race/ethnicity, CRC screening was done in n=4002 (58.9%) in Hispanics, n=723 (63.7%) Non-Hispanic Asians, n= 1341 (40.5%) Non-Hispanic African/Americans and n= 468 (34.4%) Non-Hispanic-Whites. In terms of language, CRC screening was done in n= 2842 (42.4%) English-speaking patients, n= 3071 (62%) Spanish-speaking patients and n= 575 (66.8%) Chinese-speaking patients. Conclusion: Age-appropriate CRC screening rates differed by gender, race/ethnicity, and primary language. The lower age-appropriate CRC screening rate in males is consistent with what we know about CRC screening trends in the U.S. Surprisingly, the age-appropriate CRC screening rate was higher in Non-Hispanic Asians and Hispanics, and in those who speak a language other than English. Additionally, the age-appropriate CRC screening rate was higher in non-Hispanic African Americans than in Non-Hispanic-Whites. (Table). Improvement in CRC screening in Hispanics, Non-Hispanic Asians, and non-Hispanic African Americans has likely been due to EMR best practice and care gap flags which prompt providers to screen patients. Within the immigrant population, both literacy and culture have been shown to have a strong impact on health care utilization. Diminishing disparities in screening further may require increasing patient education that is culturally sensitive and accessible for patients with low health literacy. Table 1. - Characteristics of patients, stratified by CRC screening status Patients with one or more screenings for colorectal cancer P Yes No Variable Overall (n=12,663), n (%) (n= 6565), n (%) (n= 6098), n (%) Sex at birth Male 5537 (43.7) 2531 (45.7) 3006 (54.3) < 0.01 Female 7126 (56.3) 4034 (56.6) 3092 (43.4) Race/Ethnicity Non-Hispanic - White 1359 (10.7) 468 (34.4) 891(65.5) < 0.01 Hispanic (All races) 6793 (53.6) 4002 (58.9) 2791 (41.1) Non-Hispanic African/American 3310 (26.1) 1341 (40.5) 1969 (59.5) Non-Hispanic Asian 1135 (9) 723 (63.7) 412 (36.3) Other 66 (0.52) 31(47) 35 (53) Primary Language English 6700 (52.9) 2842 (42.4) 3858 (57.6) < 0.05 Spanish 4950 (39.1) 3071 (62) 1879 (38) Chinese 861 (6.8) 575 (66.8) 286 (33.2) Other/Unreported 152 (1.2) 1 (0.6) 151. 151.(99.4)

Contraceptive care service provision via telehealth early in the COVID-19 pandemic at rural and urban federally qualified health centers in 2 southeastern states.

PurposeTo investigate telehealth use for contraceptive service provision among rural and urban federally qualified health centers (FQHCs) in Alabama (AL) and South Carolina (SC) during the initial months of the COVID‐19 pandemic.MethodsThis is a mixed‐methods study using data from the FQHC Contraceptive Care Survey and key informant interviews with FQHC staff in AL and SC conducted in 2020. Differences between rural and urban clinics in telehealth use for contraceptive service provision were assessed with a chi‐square test of independence. Interviews were audio recorded, transcribed, and coded to identify facilitators and barriers to telehealth.FindingsTelehealth for contraceptive care increased during the early months of the pandemic relative to prepandemic. Fewer rural clinics than urban clinics provided telehealth for contraceptive counseling (16.3% vs 50.6%) (P = .0002), emergency contraception (0.0% vs 16.1%) (P = .004), and sexually transmitted infection care (16.3% vs 34.6%) (P = .031). Key facilitators of telehealth were reimbursement policy, electronic infrastructure and technology, and funding for technology. Barriers included challenges with funding for telehealth, limited electronic infrastructure, and reduced staffing capacity.ConclusionsDifferences in telehealth service provision for contraceptive care between rural and urban FQHCs highlight the need for supportive strategies to increase access to care for low‐income rural populations, particularly in AL and SC. It is essential for public and private entities to support the implementation and continuation of telehealth among rural clinics, particularly, investing in widespread and clinic‐level electronic infrastructure and technology for telehealth, such as broadband and electronic health record systems compatible with telehealth technology.

Postpartum Care in the Time of COVID-19: The Use of Telemedicine for Postpartum Care.

Background: Telemedicine was implemented at our institution in response to the COVID-19 pandemic. Data do not currently exist about the use of telemedicine in providing comprehensive postpartum care. Objective: This project aimed to evaluate the impact of telemedicine on postpartum care at an urban Federally Qualified Health Center (FQHC). Study Design: This was a retrospective cohort study of patients who delivered at an urban hospital in New York between September and November 2019 (pre-COVID), February through April 2020 (peak-COVID) and June through August 2020 (ongoing-COVID). The primary outcome was postpartum visit attendance. Secondary outcomes included contraception use, breastfeeding, depression screening, hospital readmission, and emergency department visit rates. Log-binomial regression models were used to estimate relative risk. Results: Telemedicine accounted for 1% of postpartum visits in the pre-COVID cohort, 60% in the peak-COVID cohort, and 48% in the ongoing-COVID cohort. Postpartum visit attendance rates were 52% in the pre-COVID cohort, 43% in the peak-COVID cohort, and 56% in the ongoing-COVID cohort (p > 0.05). There was a nonsignificant increase in postpartum visit show rate for telemedicine visits compared to in-person visits in the peak-COVID cohort (76% vs. 65%; relative risk [RR] 1.17 [0.87-1.57]) and ongoing-COVID cohort (85% vs. 74%; RR 1.16 [0.90-1.50]). Patients were significantly less likely to have a Patient Health Questionnaire-2 Depression screen in the peak-COVID and ongoing-COVID cohorts (22% and 33%) than in the pre-COVID cohort (74%) (p < 0.01). There were no significant differences in hospital readmissions, contraceptive use or breastfeeding rates across cohorts (p > 0.05). Conclusions: At our urban FQHC, telemedicine was comparable to in-person postpartum care in terms of attendance rates during the COVID-19 pandemic, without an increase in rates of hospital visits or readmissions. However, postpartum depression screening needs to be better integrated into the telemedicine visit type.

Improving Cervical Cancer Screening Rates at an Urban Federally Qualified Health Center Family Medicine Residency Clinic.

Background Family medicine residency clinics and underserved Federally Qualified Health Center clinics often have lower rates of cervical cancer screening (CCS). Methods A series of resident-run, team-based quality improvement projects were conducted to iteratively improve CCS rates in an urban Federally Qualified Health Center in a high-need and high-demand region. Results The authors were able to improve CCS rates from 52.2% to 66.3% through 6 quality improvement projects. Conclusion Improving the clinical workflows and systems to promote better rates of CCS likely requires a series of changes, however, promoting CCS in the usual clinic workflow, regardless of the reason for visit, demonstrated the greatest gains in CCS in our setting.

Occupational health within the bounds of primary care: Factors shaping the health of Latina/o immigrant workers in federally qualified health centers.

Many workers seek care for work-related medical conditions in primary care settings. Additionally, occupational medicine training is not consistently addressed in primary care professional training. These patterns raise concerns about the health outcomes of low-wage Latina/o immigrant workers who make use of primary care settings to obtain care for work-related injuries and illnesses. The objective of this qualitative study was to investigate how primary care clinicians assessed and addressed the role of occupational exposures on the health and well-being of Latina/o immigrant workers. We conducted semistructured in-depth interviews with 17 primary care clinicians (physicians, resident physicians, and nurse practitioners) employed in an urban federally qualified health center (FQHC) with two sites located in Orange County, CA. Using a constructivist grounded theory approach, we determined that primary care clinicians had a general understanding that employment influenced the health and well-being of their Latina/o immigrant patients. Clinicians delivered care to Latina/o immigrant workers who feared reporting their injury to their employer and to Latina/o immigrants whose workers' compensation claim was terminated before making a full recovery. Clinicians were responsive to patients' work-related concerns and leveraged the resources available within the FQHC. Although some clinicians offered suggestions to improve occupational health in the FQHC, a few clinicians raised concerns about the feasibility of additional health screenings and clinic-based interventions, and pointed to the importance of interventions outside of the healthcare system. This study underscores the complexities of addressing occupational health concerns in urban FQHCs.

Mobile health technology for hypertension management with Hmong and Latino adults: mixed-methods community-based participatory research

ABSTRACT Objective To identify Hmong and Latino adults’ perspectives about a mHealth-based care model for hypertension (HTN) management involving blood pressure (BP) self-monitoring, electronic transmission of BP readings, and responsive HTN medication adjustment by a provider team. Design We conducted a mixed-methods formative study with 25 Hmong and 25 Latino participants with HTN at an urban federally-qualified health center. We used a tool to assess HTN knowledge and conducted open-ended interviews to identify perspectives about mHealth-based care model. Results While most participants agreed that lowering high blood pressure decreased the risk of strokes, heart attacks, and kidney failure, there were gaps in medical knowledge. Three major themes emerged about the mHealth-based care model: (1) Using mHealth technology could be useful, especially if assistance was available to patients with technological challenges; (2) Knowing blood pressures could be helpful, especially to patients who agreed with doctors’ medical diagnosis and prescribed treatment; (3) Transmitting blood pressures to the clinic and their responsive actions could feel empowering, and the sense of increased surveillance could feel entrapping. Some people may feel empowered since it could increase patient-provider communication without burden of clinic visits and could increase involvement in BP control for those who agree with the medical model of HTN. However, some people may feel entrapped as it could breach patient privacy, interfere with patients’ lifestyle choices, and curtail patient autonomy. Conclusions In general, Hmong and Latino adults responded positively to the empowering aspects of the mHealth-based care model, but expressed caution for those who had limited technological knowledge, who did not agree with the medical model and who may feel entrapped. In a shared decision-making approach with patients and possibly their family members, health care systems and clinicians should explore barriers and potential issues of empowerment and entrapment when offering a mHealth care model in practice.

Assessing Knowledge and Experience of Integrated Behavioral Health among Patients with Limited English Proficiency at a Diverse, Urban Federally Qualified Health Center.

Integrated behavioral health (IBH) embeds behavioral health clinicians in primary care settings to improve access and quality of care. This study investigates whether co-located IBH impacts knowledge and experiences of behavioral healthcare, particularly for individuals with limited English proficiency (LEP). 330 patients were recruited from the waiting rooms of a federally qualified health center to answer multiple-choice and Likert scale questions about behavioral healthcare. English-speaking patients were more confident in their knowledge of IBH (X2(1) = 4.79, p = .03) and external behavioral healthcare (X2(1) = 28.75, p < .001). On average, the 77 patients who accessed IBH believed that IBH appointments had a positive impact (Likert scale mean = 3.90, SD = .10). Despite satisfaction with IBH across demographic groups and similar or higher interest in behavioral health services among patients with LEP, they were found to have less knowledge about IBH than English-speaking patients.

Young Men's Health Matters: Implementing a Community-Academic Partnership in an Urban Federally Qualified Health Center.

Community-based participatory research (CBPR) approaches are being leveraged more and more in efforts to improve health equity. Informing the building of community-academic partnerships, CBPR draws on the community's expressed needs and engages stakeholders in future intervention development. To date, however, little has been published on such efforts targeting the health of young Black men (ages 18-24), despite this population's disproportionate need. In this paper, we describe the formation of a community-academic partnership in a federally qualified health center, with the goal of improving the health of young Black men in Detroit, Michigan. After conducting a needs assessment, we built upon existing networks to form a Community Advisory Board (CAB). We held three community forums during which CAB members highlighted key health issues in their community and described how they could be addressed. We developed a plan for future research and community engagement based on community input. Finally, we provide insights on community engagement strategies, forum structure, setting boundaries, trust-building, and valuable information in addressing the inequities in health that affect young Black men.

Abstract PO-253: Overcoming barriers to colorectal cancer screening for underserved patients: Lessons from the COVID-19 pandemic

Abstract Introduction This patient navigation initiative works to address cancer health disparities by improving education and access to screening and cancer care. This initiative includes partnerships with local Federally Qualified Health Centers (FQHCs) and primary care physicians (PCPs), primarily focused on increasing colorectal cancer (CRC) screening rates among underserved populations in Western New York (WNY) who may have low health literacy. Grounded in health services research, we aimed to improve clinical care by implementing evidence-based guidelines into practice by working directly with underserved communities in our area to improve CRC screening rates at an urban FQHC. Methods Throughout the COVID-19 pandemic, our navigators pivoted to a hybrid schedule with remote access to health systems, splitting time between our cancer center and remotely at home until allowed back on-site to work at the FQHC. Colonoscopy halted in NY between March and June 2020, resulting in scheduling challenges due to significant backlogs of cancelled procedures during the shutdown and regional hold on elective procedures. Endoscopists across WNY had reduced capacity for postponed procedures, leading to the prioritization of scheduling for symptomatic patients. Therefore, navigators focused screening efforts on widely disseminating stool-based tests to patients due for average-risk CRC screening and prioritizing patients with positive screening results to coordinate colonoscopy appointments. Results Between April 2020 through March 2021, our pre-pandemic goal was to educate 550 patients and screen 300 patients. During this timeframe, navigators provided screening education to 632 patients and screened 232 patients despite significant challenges presented by the COVID-19 pandemic. With many colonoscopy procedures being cancelled and/or rescheduled, stool-based tests were widely available and became a more common choice for patients. To date, since April 2020, navigators have educated 807 patients and have navigated 306 patients to complete CRC screening. Of those 306 patients, 234 chose to complete at-home stool-based testing. In 2020, CRC screening rates remained over 50%, exceeding national FQHC targets. This was achieved through targeted patient outreach, education, and navigation, despite significant challenges with the shutdown and the COVID-19 pandemic. Conclusions Stool-based tests paired with targeted outreach and education were an efficient tool for CRC screening during this challenging time. Navigators regularly cross-check records to be sure results are received by ordering physicians and properly coded for accurate data reporting. This is especially important for positive test results and timely follow up, which may lead to improved health outcomes. Moving forward, this paired approach may be an effective strategy for improving screening rates among hard-to-reach patient populations and patients facing substantial barriers to accessing routine medical care. Citation Format: Kathryn M. Glaser, Christina Crabtree-Ide, Alyssa McNulty, Ellis Gomez, Nicole Donofrio, Tessa Flores, Mary E. Reid. Overcoming barriers to colorectal cancer screening for underserved patients: Lessons from the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-253.

918. 2019 Implementation of Universal Hepatitis C Screening at an Urban Federally Qualified Health Center: A Descriptive Analysis and Lessons Learned

BackgroundHepatitis C infection (HCV) is a curable disease that can be effectively managed by non-specialists. Delaware has high HCV rates but limited resources to care for individuals with HCV. Successful HCV micro-elimination starts with universal HCV screening and case identification. MethodsChristianaCare (CC) and Westside Family Healthcare (WFH), Delaware’s largest federally qualified health center (FQHC), created a multidisciplinary initiative to support comprehensive HCV care from July 2018-2020 (Figure 1). As part of this partnership, universal opt-out HCV screening in eligible (no prior HCV RNA result) adults ≥ 18 years was implemented at a pilot site in Wilmington in 2019. To characterize screening practices, pre- (risk-based screening) and post-intervention (universal screening) electronic health record data was collected following the first 6 months of the intervention (Jan-June 2019). An HCV dashboard was created and updated monthly to evaluate trends in 2019 screening rates. Collaboration was supported through a 2-year CC Harrington grant. Figure 1. Components of Federally Qualified Health Center HCV Medical Care Model Table 1. Pilot Site Patient Characteristics ResultsPre- and post-intervention patient characteristics and screening data are presented in Table 1 and Figure 2 respectively. 39% of patients had screening ordered during the first 6 months of universal screening, a 4% increase from baseline. HCV seroprevalence [amongst resulted tests] remained unchanged from baseline at 5%. During the universal screening period, 2.5% (12/482) of individuals with resulted tests had HCV compared to 4.0% (29/795) tested during risk-based screening. HCV dashboard data demonstrated a trend of increased ordering and fulfillment of screening tests (Figure 3). Figure 3. 2019 HCV Dashboard ConclusionThe early adoption of universal HCV screening in adults (prior to 2020 USPSTF update) at an urban FQHC, together with an initiative to provide multidisciplinary HCV care at this FQHC (Figure 1), led to increasing rates of ordered screening. The presented 6-month data does not fully account for lag times between test ordering and fulfillment, resulting in under-reporting of universal HCV screening rates. Multidisciplinary care models to address HCV in patients’ medical homes are vital to HCV eradication with the robust implementation of universal HCV screening a vital first step in this continuum. Disclosures Deborah A. Kahal, MD,MPH, FACP, Gilead (Speaker’s Bureau)Viiv (Speaker’s Bureau)

Provider and coach perspectives on implementing shadow coaching to improve provider-patient interactions.

Healthcare organizations want to improve patient care experiences. Some use 'shadow coaching' to improve interactions between providers and patients. A Federally Qualified Health Center (FQHC) implemented a half-day observation of individual primary-care providers by a 'shadow coach' during real-time patient visits, including an in-person verbal debrief afterwards and a written report with specific recommendations. Shadow coaching identified areas for improvement. We aimed to characterize lessons and barriers to implementing shadow coaching as a mechanism to improve interactions with patients and change organizational culture. We examined provider and coach perceptions of shadow coaching through interviewing coached providers, stratified by provider type and Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance, and the coaches who coached the most providers. We interviewed 19 coached providers and 2 coaches in a large, urban FQHC. Content analysis identified implementation barriers, facilitators and themes. Coaches reported needing 'buy-in' throughout the organization and the need to be credible and empathize with the providers being coached. Most providers reported behaviour changes based on recommendations. Almost all providers recalled at least one coaching recommendation that was actionable. Providers and coaches highlighted patient-level and practise-level barriers that impeded their ability to implement recommended improvements. CAHPS data was reported as an effective performance management metric for measuring change, counselling providers, and evaluating provider-level efforts but was not always specific enough to yield tangible recommendations. Regular messaging by leadership about the priority and purpose of shadow coaching was essential for both physician engagement and its mature implementation across the organization. Coaching could be embedded into a long-term strategy of professional development with periodic re-coaching. Re-coaching sessions could target issues raised by providers, such as dealing with difficult patients or specific populations. Research on the timing and content of re-coaching is needed.

Rapid Adoption of Telehealth Due to the COVID-19 Pandemic in A Large Urban Federally Qualified Health Center – Adapting the Pediatric Model to Care for Patients in Need

Rapid Adoption of Telehealth Due to the COVID-19 Pandemic in A Large Urban Federally Qualified Health Center – Adapting the Pediatric Model to Care for Patients in Need

Implementing a Substance Use Screening Protocol in Rural Federally Qualified Health Centers.

In 2018, nearly 20% of Americans aged 12 years and older reported using illicit substances, with higher rates in rural areas. Federally Qualified Health Centers (FQHCs) provide health care to one in five rural Americans. However, estimates suggest that only 13.6% of patients in rural FQHCs receive substance use (SU) screening compared with 42.6% of patients in urban FQHCs. This quality improvement (QI) project aimed to improve patient quality and safety and meet Health Resources and Services Administration reporting requirements. These aims were achieved through the design and implementation of a new SU screening protocol in four FQHCs in rural Indiana. Deming's plan-do-study-act model was used to implement QI interventions to increase SU screening rates. A new SU screening tool, the National Institute on Drug Abuse -Modified Alcohol, Smoking, and Substance Involvement Screening Testwas implemented, and staff were trained on its use. the screening, brief intervention, and referral to treatment model was used as a guiding framework. Outcome measures included a comparison of SU screening rates from the first quarter of 2019 to the first quarter of 2020, as well a pretest-posttest designed to measure staff knowledge and attitudes regarding SU. Baseline SU screening rate in 2019 was 0.87%. This increased to 24.8% by March 2020. Additionally, posttest results demonstrated improvement from staff on all indices, and an approval rating of 77% of the new SU screening practices. This project demonstrated that a low-cost QI intervention can increase SU screening rates in rural FQHCs, as well as improve staff knowledge and attitudes regarding SU.