scholarly journals What’s the “Secret Sauce”? How Implementation Variation Affects the Success of Colorectal Cancer Screening Outreach

2020 ◽  
Author(s):  
Jennifer Coury ◽  
Edward J. Miech ◽  
Patricia Styer ◽  
Amanda F. Petrik ◽  
Kelly E. Coates ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health System ◽  
Health Systems ◽  
Descriptive Analysis ◽  
Regression Line ◽  
System Size ◽  
Crc Screening ◽  
Mailing Lists ◽  
One Year ◽  
System Characteristics

Abstract Background: Mailed fecal immunochemical testing (FIT) programs can improve colorectal cancer (CRC) screening rates, but health systems vary how they implement (i.e., adapt) these programs for their organizations. A health insurance plan implemented a mailed FIT program (named BeneFIT) and participating health systems could adapt the program. This multi-method study explored which program adaptations might have resulted in higher screening rates.Methods: First, we conducted a descriptive analysis of CRC screening rates by key health system characteristics and program adaptations. Second, we generated an overall model by fitting a weighted regression line to our data. Third, we applied Configurational Comparative Methods (CCMs) to determine how combinations of conditions were linked to higher screening rates. The main outcome measure was CRC screening rates.Results: Seventeen health systems took part in at least one year of BeneFIT. The overall screening completion rate was 20% (4%–28%) in Year 1, and 25% (12%–35%) in Year 2 of the program. Health systems that used two or more adaptations had higher screening rates, and no single adaptation clearly led to higher screening rates. In Year 1, small systems, with just one clinic, that used phone reminders (n=2) met the implementation success threshold (≥19% screening rate) while systems with >1 clinic were successful when offering a patient incentive (n=4), scrubbing mailing lists (n=4), or allowing mailed FIT returns with no other adaptations (n=1). In Year 2, larger systems with 2-4 clinics were successful with a phone reminder (n=4) or a patient incentive (n=3). Of the 10 systems that implemented BeneFIT in both years, seven improved their CRC screening rates in Year 2.Conclusions: Health systems can choose among many adaptations and successfully implement a health plan’s mailed FIT program. Different combinations of adaptations led to success with health system size emerging as an important contextual factor.

scholarly journals What’s the “Secret Sauce”? How Implementation Variation Affects the Success of Colorectal Cancer Screening Outreach

2020 ◽  
Author(s):  
Jennifer Coury ◽  
Edward J. Miech ◽  
Patricia Styer ◽  
Amanda F. Petrik ◽  
Kelly E. Coates ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health System ◽  
Health Systems ◽  
Descriptive Analysis ◽  
System Size ◽  
Crc Screening ◽  
Explanatory Factors ◽  
Mailing Lists ◽  
Multi Method Approach ◽  
One Year

Abstract Background: Mailed fecal immunochemical testing (FIT) programs can improve colorectal cancer (CRC) screening rates, but health systems often vary implementation (i.e., adapt) these programs for their organizations. A health insurance plan implemented a mailed FIT program (named BeneFIT) and allowed participating health systems to adapt the program. This mixed-methods study explored which program adaptations might have achieved higher screening rates.Methods: We used a multi-method approach. First, we conducted a descriptive analysis of CRC screening rates by key health system characteristics and program adaptations. Second, we applied Configurational Comparative Methods (CCMs) to determine potential explanatory factors consistent with higher screening rates. The main outcome measure was CRC screening rates.Results: Seventeen health systems took part in at least one year of BeneFIT. The overall screening completion rate was 20% (4%–28%) in Year 1, and 25% (12%–35%) in Year 2 of the program. Health systems that used two or more adaptations had higher screening rates, and no single adaptation clearly led to higher screening rates. In Year 1, smaller systems (having <2 clinics) with phone reminders (n=2) met the implementation success threshold (≥19% screening rate) while larger systems were successful when offering a patient incentive (n=4), scrubbing mailing lists (n=4), or allowing mailed FIT returns with no other adaptations (n=1). In Year 2, large systems (>2 clinics) were successful with a phone reminder (n=4) or a patient incentive (n=3). Of the 10 systems that implemented BeneFIT in both years, seven improved in Year 2.Conclusions: Health systems can choose between many adaptations and successfully implement a health plan’s mailed FIT program. Screening completion rates are positively associated with the number of adaptations implemented by a health system. Health system size emerged as an important contextual factor, with different solutions for larger than smaller health systems.

scholarly journals What’s the “Secret Sauce”? How Implementation Variation Affects the Success of Colorectal Cancer Screening Outreach

2020 ◽  
Author(s):  
Jennifer Coury ◽  
Edward J. Miech ◽  
Patricia Styer ◽  
Amanda F. Petrik ◽  
Kelly E. Coates ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Health Care Providers ◽  
Descriptive Analysis ◽  
Care Providers ◽  
Screening Rate ◽  
Crc Screening ◽  
Fecal Immunochemical Testing

Abstract Background Mailed fecal immunochemical testing (FIT) programs can improve colorectal cancer (CRC) screening rates, but health systems often vary implementation (i.e., adapt) these programs for their organizations. A health insurance plan implemented a mailed FIT program (named BeneFIT) and allowed participating health systems to adapt the program. This mixed-methods study explored which program adaptations might have achieved higher screening rates.Methods We used a multi-method approach. First, we conducted a descriptive analysis of CRC screening rates by key health system characteristics and program adaptations. Second, we applied Configurational Comparative Methods (CCMs) to determine potential explanatory factors consistent with higher screening rates. The main outcome measure was CRC screening rates.Results Seventeen health systems took part in at least one year of BeneFIT. The overall screening completion rate was 20% (4–28%) in Year 1, and 25% (12–35%) in Year 2 of the program. Health systems that used two or more adaptations had higher screening rates, and no single adaptation clearly led to higher screening rates. In Year 1, smaller systems (having < 2 clinics) with phone reminders (n = 2) met the implementation success threshold (≥ 19% screening rate) while larger systems were successful when offering a patient incentive (n = 4), scrubbing mailing lists (n = 4), or allowing mailed FIT returns with no other adaptations (n = 1). In Year 2, large systems (> 2 clinics) were successful with a phone reminder (n = 4) or a patient incentive (n = 3). Of the 10 systems that implemented BeneFIT in both years, seven improved in Year 2.Conclusions Health systems can choose between many adaptations and successfully implement a health plan’s mailed FIT program. Screening completion rates are positively associated with the number of adaptations implemented by a health system. Health system size emerged as an important contextual factor, with different solutions for larger than smaller health systems.Contributions to the Literature· Our paper analyzes adaptations that enable health care providers to implement mailed fecal immunochemical testing (FIT) programs in delivery systems.· Our results explore which adaptations made by health systems to mailed FIT programs are related to screening rate improvements. Our analysis shows that a health system’s organizational characteristics in combination with the adaptations themselves may affect resulting CRC screening rates and implementation.· Our paper describes different pathways that health care organizations can use to implement CRC screening outreach to improve the health of their populations. We show results of implementation flexibility and customizing CRC screening outreach to particular clinic environments.

scholarly journals Primary care providers’ beliefs and practices on colorectal cancer screening in Kuwait

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E L Tolma ◽  
S M Aljunid ◽  
M N Amrizal ◽  
J Longenecker ◽  
A Al-Basmy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Health System ◽  
Screening Test ◽  
Primary Care Providers ◽  
Screening Tests ◽  
Care Providers ◽  
Beliefs And Practices ◽  
Crc Screening

Abstract Background Colorectal cancer (CRC) is a major public health issue in the Arab region. In Kuwait, CRC is the second most frequent cancer, with an age-standardized (world) incidence rate of 13.2 cases/100,000 in 2018. Despite the national efforts to promote CRC screening the current participation rate is very low (5 to 17%). Primary Care Providers (PCPs) are considered as the gatekeepers of cancer screening globally. This is one of the first studies in Kuwait that examined the current beliefs/practices of PCPs on CRC screening. Methods This cross-sectional study was conducted at governmental primary care centers in Kuwait from 2015-2017. Of 564 PCPs invited to participate from all centers, 255 completed the self-administered questionnaires. The 14-page survey contained 75 questions on PCPs’ beliefs and practices of CRC screening. Data were analyzed by using descriptive statistics. Results The study sample consisted primarily of females (52.0%) and non-Kuwaiti (79%) physicians, with mean age =43.3 (SD: 11.2) years. Most respondents (92%) believed that colonoscopy is the most effective screening tool. The majority (78%) reported that they recommend CRC screening to their patients, with colonoscopy as the most frequent modality (87%) followed by the Faecal Occult Blood Test (FOBT) (52%). Around 40% of the respondents stated that they did not have time to discuss CRC screening with their patients. The majority (72%) believed that their patients did not complete their CRC screening tests. Health system related barriers included difficulties in obtaining test results from the gastroenterologist (61.4%), ordering follow-up test after a positive screening test (50.6%) and shortage of trained staff to conduct the screening test (44.2%). Conclusions A majority of PCPs in Kuwait recommend CRC screening to their patients, but not all patients follow through their recommendation. More research is needed to find out how to further enhance patient uptake of CRC screening. Key messages Colonoscopy is the most frequent screening CRC modality used in Kuwait. Health system related factors can be important future intervention targets to promote CRC screening.

scholarly journals Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

2020 ◽  
Vol 2020 ◽  
pp. 1-23 ◽  
Author(s):  
Maria Gabriella Melchiorre ◽  
Roberta Papa ◽  
Sabrina Quattrini ◽  
Giovanni Lamura ◽  
Francesco Barbabella ◽  
...  
Keyword(s):  
Older People ◽  
Health System ◽  
Integrated Care ◽  
Health Systems ◽  
National Health ◽  
European Countries ◽  
Financing System ◽  
Major Barrier ◽  
Case Study Methodology ◽  
System Characteristics

Introduction. eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. Materials and Methods. In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). Results. 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. Conclusions. Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.

scholarly journals Does the Flemish colorectal cancer screening programme reach equity in FIT uptake?

2019 ◽  
Vol 29 (6) ◽  
pp. 1108-1114
Author(s):  
S Hoeck ◽  
W van de Veerdonk ◽  
I De Brabander ◽  
E Kellen
Keyword(s):  
Colorectal Cancer ◽  
Minimum Wage ◽  
Screening Programme ◽  
Economic Status ◽  
Descriptive Analysis ◽  
Population Based ◽  
Crc Screening ◽  
Screening Uptake ◽  
Study Results ◽  
Significant Difference

Abstract Background To investigate colorectal cancer (CRC) screening rates by the faecal immunochemical test (FIT) according to sociodemographic characteristics and nationality. Methods Men and women, aged 56–74, invited to participate in the Flemish CRC screening programme in 2013 and 2014 were included in this study. We analysed the association between CRC screening uptake and sex, age, (first and current) nationality and several proxies for socio-economic status (SES). The statistical analysis was based on descriptive analyses and logistic regression models. Results A total of 1 184 426 persons were included in our analysis. The overall screening uptake was 52.3%, uptake varied by sex, age, nationality and SES. Lower participation rates were associated with the youngest and oldest age categories (56–60 and 70–74) and being male. All nationalities other than Belgian or Dutch were significantly less screened. Lower uptake of screening was also associated with several proxy’s for low SES, such as having an allowance for being disabled, not being able to work, being an extended minor and having a social allowance/minimum wage. The descriptive analysis showed a 27% difference in CRC screening uptake between the (early) retired and the people entitled to a minimum wage. Conclusions There is a significant difference between screening uptake and demographic and socio-economic variables in the first 2 years of the population-based screening programme in Flanders. Based on the study results, implementing strategies to improve participation in those subgroups is needed.

scholarly journals The influence of health systems on breast, cervical and colorectal cancer screening: an overview of systematic reviews using health systems and implementation research frameworks

2019 ◽  
Vol 25 (1) ◽  
pp. 49-58 ◽  
Author(s):  
Jennifer Priaulx ◽  
Eleanor Turnbull ◽  
Eveline Heijnsdijk ◽  
Marcell Csanádi ◽  
Carlo Senore ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Health System ◽  
Health Systems ◽  
Systematic Reviews ◽  
Healthcare Professionals ◽  
Barriers And Facilitators ◽  
Average Risk ◽  
Opportunistic Screening ◽  
Systems Research

Objectives Screening for breast, cervical and colorectal cancer in an average-risk population is widely recommended in national and international guidelines although their implementation varies. Using a conceptual framework that draws on implementation and health systems research, we provide an overview of systematic literature reviews that address health system and service barriers or facilitators to effective cancer screening. Methods Using a systematic approach, we searched Cochrane Database of Systematic Reviews, Ovid Medline, Ovid Embase, Web of Science, PsychInfo and other internet sources. We included systematic reviews of screening interventions (i.e. targeting people at average risk) for breast, cervical and colorectal cancer. The analysis included 90 systematic reviews. Results This review identified a multitude of barriers and facilitators affecting the health system, the capabilities of individuals in the system and their intentions. A large proportion of the available evidence focused on uptake. The reviews demonstrated that health system factors influenced participation, as well as quality and effectiveness of the service provided. The barriers with the biggest impact were knowledge/education, mainly of clients but also providers (capability barriers) and beliefs and values (intention barriers) of the eligible population. These findings complement the usual focus on psychological and social barriers to informed participation by individuals that dominate the screening literature. The facilitators with the most supporting evidence were educational interventions (overcoming capability and intention barriers), invitation letters, reminders and appointments. These were mainly directed at eligible individuals and, to a lesser extent, to providers and healthcare professionals. Only a small number of reviews, mainly from Europe, specified organized, rather than opportunistic, screening programmes. In those, low participation was the most frequently cited barrier and invitation letters (including physician endorsement, phone calls and reminders to non-responders and healthcare professionals) were the most prevalent facilitators. Conclusion Despite evidence of barriers and facilitators to screening participation and opportunistic screening, further health systems research covering the entire screening system for organized programmes is required.

scholarly journals Colorectal Cancer Screening Completion Among Individuals With and Without Mental Illnesses: A Comparison of 2 Screening Methods

2017 ◽  
Vol 32 (4) ◽  
pp. 925-931 ◽  
Author(s):  
Bobbi Jo H. Yarborough ◽  
Ginger C. Hanson ◽  
Nancy A. Perrin ◽  
Scott P. Stumbo ◽  
Carla A. Green
Keyword(s):  
Colorectal Cancer ◽  
Mental Illness ◽  
Health System ◽  
Psychotic Disorders ◽  
Occult Blood ◽  
Mental Illnesses ◽  
Fecal Occult Blood ◽  
Screening Methods ◽  
Average Risk ◽  
Crc Screening

Purpose: Cancer mortality is worse among people with psychiatric disorders. The purpose of this study was to compare facilitators and rates of colorectal cancer (CRC) screening between people with and without mental illnesses. Design: We conducted a secondary analysis using data from a general population cohort study (N = 92 445) that assessed effects of 2 types of CRC screening test kits—guaiac fecal occult blood testing (gFOBT) and fecal immunochemical testing (FIT)—on CRC screening completion. Setting: The setting was a health system that served approximately 485 000 members in urban and suburban Oregon and Washington. Participants: Participants were health system members, categorized by mental illness diagnosis (psychotic disorders, non-psychotic unipolar depression, and no mental illness), who were age-eligible, at average risk of CRC, and were at least 366 days past their last gFOBT with no evidence of other CRC screening. Measures: The outcome was time until completion of CRC screening. Analysis: We used Cox proportional hazard models. Results: FIT reduced CRC screening barriers for all the groups. Compared to people without mental illness diagnoses, those with psychotic disorders were equally likely to screen using FIT (hazard ratio [HR] = .95, p = .679) and those with depression were more likely (HR = 1.17, p = .006). Conclusions: FIT can improve CRC screening rates among people with mental illnesses, particularly depression.

scholarly journals RE-AIM Evaluation of a Multilevel Decision Support and Navigation Intervention for Colorectal Cancer Screening in Hispanic Primary Care Patients

2020 ◽  
Author(s):  
Beth Careyva ◽  
Melanie Johnson ◽  
Randa Sifri ◽  
Melissa DiCarlo ◽  
Constantine Daskalakis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Decision Support ◽  
Health System ◽  
The United States ◽  
Crc Screening ◽  
Hispanic Adults ◽  
Primary Care Patients ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background: Hispanic adults in the United States have low colorectal cancer (CRC) screening rates and are more likely than non-Hispanic adults to be diagnosed with advanced-stage CRC. We evaluated the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a novel multilevel decision support and navigation intervention (DSNI) designed to increase CRC screening among Hispanic primary care patients.Methods: The trial enrolled 400 consented participants from a health system sampling frame of 2,720 Hispanic patients eligible for CRC screening in five primary care practices. We randomized 203 patients to receive a mailed standard intervention (SI Group) that included informational material, a fecal immunochemical test kit, a reminder versus 197 patients who received the SI plus a telephone screening DSNI (DSNI Group). We assessed DSNI effects using health system and study administrative data.Results: 1) Reach: DSNI delivery reached 84% of participants. 2) Effectiveness: The DSNI group produced a screening rate that was significantly greater (p < .001) than in the SI group (78% and 43%, respectively). 3) Adoption: All participating primary care practices and patients remained in the study. 4) Implementation: DSNI delivery required an average of 4.1 decision support and navigation call attempts with the total call effort averaging 35 minutes. 5) Maintenance: Health system leaders have acknowledged DSNI benefits and are actively engaged in determining how to sustain DSNI implementation.Conclusion: The DSNI achieved high levels of reach, effectiveness, adoption, and implementation with a modest investment of resources. The project team is addressing the challenge of DSNI maintenance in the health system. Further work is needed to determine intervention effectiveness in other health systems and in the general patient population. Trial Registration: ClinicalTrials.gov identifier : NCT02272244

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals 22.F. Workshop: What makes for resilient health systems? Evidence from the State of Health in the EU country profiles

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
The State ◽  
Lessons Learned ◽  
Three Dimensions ◽  
Health System Strengthening ◽  
New Work ◽  
State Of Health ◽  
The Eu

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

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