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Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study
OBJECTIVE: To describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO). DESIGN: This study used a multiple case...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710423/ https://www.ncbi.nlm.nih.gov/pubmed/34937796 http://dx.doi.org/10.1136/fmch-2021-001326 |
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author | Nelson-Brantley, Heather Ellerbeck, Edward F McCrea-Robertson, Stacy Brull, Jennifer Bacani McKenney, Jennifer Greiner, K Allen Befort, Christie |
author_facet | Nelson-Brantley, Heather Ellerbeck, Edward F McCrea-Robertson, Stacy Brull, Jennifer Bacani McKenney, Jennifer Greiner, K Allen Befort, Christie |
author_sort | Nelson-Brantley, Heather |
collection | PubMed |
description | OBJECTIVE: To describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO). DESIGN: This study used a multiple case study design. Purposive sampling was used to identify a diverse group of practices within the ACO. Data were collected from focus group interviews and workflow mapping. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. Data were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening implementation. SETTING: The study included eight rural primary care practices, defined as Rural-Urban Continuum Codes 5–9, in one ACO in the Midwestern United States. PARTICIPANTS: Providers, staff and administrators who worked in the primary care practices participated in focus groups. 28 individuals participated including 10 physicians; one doctor of osteopathic medicine; three advanced practice registered nurses; eight registered nurses, quality assurance and licensed practical nurses; one medical assistant; one care coordination manager; and four administrators. RESULTS: With integration into the ACO, practices adopted four new strategies to support cancer screening: care gap lists, huddle sheets, screening via annual wellness visits and information spread. Cross-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies, although workflows varied widely across practices. Each of the four strategies was adapted for fit to the local context of the practice. Participants shared that joining the ACO provided a strong external incentive for increasing cancer screening rates. Two predominant determinants of cancer screening success at the clinic level were use of the electronic health record (EHR) and fully engaging nurses in the screening process. CONCLUSIONS: Joining an ACO can be a positive driver for increasing cancer screening practices in rural primary care practices. Characteristics of the practice can impact the success of ACO-related cancer screening efforts; engaging nurses to the fullest extent of their education and training and integrating cancer screening into the EHR can optimise the cancer screening workflow. |
format | Online Article Text |
id | pubmed-8710423 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-87104232022-01-10 Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study Nelson-Brantley, Heather Ellerbeck, Edward F McCrea-Robertson, Stacy Brull, Jennifer Bacani McKenney, Jennifer Greiner, K Allen Befort, Christie Fam Med Community Health Original Research OBJECTIVE: To describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO). DESIGN: This study used a multiple case study design. Purposive sampling was used to identify a diverse group of practices within the ACO. Data were collected from focus group interviews and workflow mapping. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. Data were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening implementation. SETTING: The study included eight rural primary care practices, defined as Rural-Urban Continuum Codes 5–9, in one ACO in the Midwestern United States. PARTICIPANTS: Providers, staff and administrators who worked in the primary care practices participated in focus groups. 28 individuals participated including 10 physicians; one doctor of osteopathic medicine; three advanced practice registered nurses; eight registered nurses, quality assurance and licensed practical nurses; one medical assistant; one care coordination manager; and four administrators. RESULTS: With integration into the ACO, practices adopted four new strategies to support cancer screening: care gap lists, huddle sheets, screening via annual wellness visits and information spread. Cross-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies, although workflows varied widely across practices. Each of the four strategies was adapted for fit to the local context of the practice. Participants shared that joining the ACO provided a strong external incentive for increasing cancer screening rates. Two predominant determinants of cancer screening success at the clinic level were use of the electronic health record (EHR) and fully engaging nurses in the screening process. CONCLUSIONS: Joining an ACO can be a positive driver for increasing cancer screening practices in rural primary care practices. Characteristics of the practice can impact the success of ACO-related cancer screening efforts; engaging nurses to the fullest extent of their education and training and integrating cancer screening into the EHR can optimise the cancer screening workflow. BMJ Publishing Group 2021-12-22 /pmc/articles/PMC8710423/ /pubmed/34937796 http://dx.doi.org/10.1136/fmch-2021-001326 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Nelson-Brantley, Heather Ellerbeck, Edward F McCrea-Robertson, Stacy Brull, Jennifer Bacani McKenney, Jennifer Greiner, K Allen Befort, Christie Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study |
title | Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study |
title_full | Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study |
title_fullStr | Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study |
title_full_unstemmed | Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study |
title_short | Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study |
title_sort | implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710423/ https://www.ncbi.nlm.nih.gov/pubmed/34937796 http://dx.doi.org/10.1136/fmch-2021-001326 |
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