Promoting colorectal cancer screening through a new model of delivering rural primary care in the USA: a qualitative study.
INTRODUCTION
Despite the known benefits of colorectal cancer (CRC) screening, rural areas have consistently reported lower screening rates than their urban counterparts. Alternative healthcare delivery models, such as accountable care organizations (ACOs), have the potential to increase CRC rates through collaboration among healthcare providers with the aim of improving quality and decreasing cost. However, researchers have not sufficiently explored how this innovative model could influence the promotion of cancer screening. The purpose of the study was to explore the mechanism of how CRC screening can be promoted in ACO-participating rural primary care clinics.


METHODS
The study collected qualitative data from in-depth interviews with 21 healthcare professionals employed in ACO-participating primary care clinics in rural Nebraska. Participants were asked about their views on opportunities and challenges to promote CRC screening in an ACO context. Data were analyzed using a grounded theory approach.


RESULTS
The study found that the new healthcare delivery model can offer opportunities to promote cancer screening in rural areas through enhanced electronic health record use, information sharing and collaborative learning within ACO networks, use of standardized quality measures and performance feedback, a shift to preventive/comprehensive care, adoption of team-based care, and empowered care coordinators. The perceived challenges were found in financial instability, increased staff workload, lack of provider training/education, and lack of resources in rural areas.


CONCLUSIONS
This study found that the innovative care delivery model, ACO, could provide a well-designed platform for promoting CRC screening in rural areas, if sustainable resources (eg finance, health providers, and education) are provided. This study provides 'practical' information to identify effective and sustainable intervention programs to promote preventive screening. Further efforts are needed to facilitate delivery system reforms in rural primary care, such as improving performance evaluation measures and methods.
['Kim|Jungyoon|J|', 'Young|Lufei|L|', 'Bekmuratova|Sarbinaz|S|', 'Schober|Daniel J|DJ|', 'Wang|Hongmei|H|', 'Roy|Shreya|S|', 'Bhuyan|Soumitra S|SS|', 'Schumaker|Alice|A|', 'Chen|Li-Wu|LW|']
D060866:Accountable Care Organizations D000368:Aged D015179:Colorectal Neoplasms D055088:Early Detection of Cancer D005260:Female D006801:Humans D008297:Male D008507:Medically Underserved Area D008875:Middle Aged D015233:Models, Statistical D009329:Nebraska D036301:Qualitative Research D019035:Rural Health Services D012424:Rural Population
Cancer Administrator Health Service reform Management/Administration Medical North America Nursing Qualitative Research