Improving Cancer Screening and Follow-up in Community Health Centers

The research team has a strong partnership with Azara Healthcare, which provides a

population management platform to 325 community health centers (CHCs) in 30 US states.

This platform, the Data Reporting and Visualization System (DRVS), allows for population-

and patient-level tracking and data visualization. Individual CHCs can customize DRVS by

using different functionalities that track specific conditions or care gaps. The aim of

this study is to pilot test an implementation intervention to integrate new DRVS tools

into practice and assess its impact on timely screening and follow-up in health centers

based on availability of patient navigators. This is a small, pre-post design pilot test

in which the research team will implement screening tools and practice facilitation over

a 4-month period and examine rates of screening referrals, screening completion, and

diagnostic resolution. The research team will select up to 4 CHCs to participate (two

with patient navigation for cancer screening care and two without patient navigation).

The CHCs will be selected from among those who use the DRVS system and express interest

in the study. As agreed on by sites, the decision to participate in the intervention will

be made at the site-level through collaboration with facility leadership and state

primary care associations. The intervention is a practice-level clinical strategy that

consists of routine care. Participants will be CHC staff whose duties include helping

patients to complete cancer screening and follow-up of abnormal tests as well as CHC

patients who experience a clinical encounter as a result of use of the tools. As part of

the usual DRVS tool roll-out, Azara will provide staff with 1.5 hours of training on use

of the new DRVS tools. The research team anticipates using facilitation as an

implementation strategy to troubleshoot intervention workflows and to troubleshoot

intervention workflows and monitor implementation. However, the team will be evaluating

CHC barriers to implementation and may use alternative implementation strategies if

warranted. The CHC staff member who interacts with the DRVS in relation to cancer

screening will then, as part of the study, participate in 6 hours of facilitation over 4

months to troubleshoot intervention workflows and monitor implementation. The CHC staff

who participate in the implementation will be asked to participate in one follow-up,

virtual interview. The research team will use coded data to examine the impact of the

tools on patient screening outcomes. The team will not have access to the codes that

would allow identification (as will be specified in the data use agreement [DUA] with

Azara).

The human-subjects research aspect of this project consists of an evaluation of the

implementation intervention with up to 3 staff and 2 patients per CHC via one-hour

interviews. The CHC staff whose duties include use of the DRVS tools for cancer screening

will participate in a semi-structured interview (up to 60 minutes) to assess their

experience with the intervention and ideas for further improvements. Patients who

interact with the clinic because of the CHCs use of the tools will also participate in a

semi-structured interview (up to 60 minutes) to assess their experiences. The CHCs that

agree to participate in the study will be informed at the time of their agreement that

staff that use the screening tools and patients who have a clinical encounter because of

use of the screening tools will be asked to participate in interviews to assess their

experience with the tools. Following completion of the pilot intervention test period,

the research team will send the designated staff or patient an email invitation to

participate in the interview. The email will include a description of the study purpose.

Interview questions for staff will cover the use of tools by asking participants to

describe how the tools are integrated into their daily practice, as well as perceived

barriers and facilitators to using the tools and strategies to overcome barriers.

Interview questions for patient participants will cover their experiences with the

follow-up and support provided by the CHC staff related to closing their screening gaps.

Interviews will be conducted via zoom or the participant's preferred platform. A research

assistant will sit in on the interviews to take notes. Interviews will be audio-recorded,

and recordings will be saved on a secure HSPH drive. Participants' involvement is

complete after the interview.