Delivery of Cervical and Colorectal Cancer Screenings During the Pandemic in Community Health Centers: Practice Changes and Recovery Strategies.
Delivery of Cervical and Colorectal Cancer Screenings During the Pandemic in Community Health Centers: Practice Changes and Recovery Strategies.
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DOI：
10.1097/mlr.0000000000001879
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发表时间：
2023-08-01
期刊：
影响因子：
3
通讯作者：
Cohen, Deborah J.
中科院分区：
文献类型：
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作者：
Huguet, Nathalie;Danna, Maria;Baron, Andrea;Hall, Jennifer;Hodes, Tahlia;O'Malley, Jean;Holderness, Heather;Marino, Miguel;DeVoe, Jennifer E.;Cohen, Deborah J.
2019冠状病毒病大流行导致临床实践发生变化，影响了癌症预防护理的提供。调查2019年冠状病毒病大流行对结直肠癌（CRC）和宫颈癌（CVC）筛查的影响。使用电子健康记录数据（2019年1月至2021年7月期间提取）的平行混合方法设计。研究结果集中在3个与大流行相关的时期：2020年3月至5月，2020年6月至10月和2020年11月至2021年9月。13个州的217个社区卫生中心和13个社区卫生中心的29个半结构化访谈。年龄和性别合格患者的每月最新CRC和CVC筛查率以及完成结肠镜检查、粪便免疫化学试验（FIT）/粪便潜血试验（FOBT）程序、巴氏试验的每月比率。分析采用广义估计方程Poisson模型。定性分析人员编写了案例摘要，并创建了跨案例数据显示以供比较。结果显示，结肠镜检查降低75%[率比（RR）= 0.250，95%CI：0.224-0.279]，FIT/FOBT降低78（RR = 0.218，95%CI：0.208-0.230），而在大流行开始后，Papanicolaou的发病率为87%（RR = 0.130，95%CI：0.125-0.136）。在大流行早期，CRC筛查受到医院停止服务的影响。诊所工作人员转向FIT/FOBT筛查。CVC筛查受到鼓励暂停CVC筛查的指南、患者不情愿和对暴露的担忧的影响。在恢复期间，领导力驱动的预防性护理优先化和质量改进能力影响了CRC和CVC筛查的维持和恢复。支持质量改进能力的努力可能是这些卫生中心承受其医疗服务系统重大中断并推动快速恢复的关键可行因素。
The coronavirus disease 2019 pandemic led to clinical practice changes, which affected cancer preventive care delivery. To investigate the impact of the coronavirus disease 2019 pandemic on the delivery of colorectal cancer (CRC) and cervical cancer (CVC) screenings. Parallel mixed methods design using electronic health record data (extracted between January 2019 and July 2021). Study results focused on 3 pandemic-related periods: March–May 2020, June–October 2020, and November 2020–September 2021. Two hundred seventeen community health centers located in 13 states and 29 semistructured interviews from 13 community health centers. Monthly up-to-date CRC and CVC screening rates and monthly rates of completed colonoscopies, fecal immunochemical test (FIT)/fecal occult blood test (FOBT) procedures, Papanicolaou tests among age and sex-eligible patients. Analysis used generalized estimating equations Poisson modeling. Qualitative analysts developed case summaries and created a cross-case data display for comparison. The results showed a reduction of 75% for colonoscopy [rate ratio (RR) = 0.250, 95% CI: 0.224–0.279], 78% for FIT/FOBT (RR = 0.218, 95% CI: 0.208–0.230), and 87% for Papanicolaou (RR = 0.130, 95% CI: 0.125–0.136) rates after the start of the pandemic. During this early pandemic period, CRC screening was impacted by hospitals halting services. Clinic staff moved toward FIT/FOBT screenings. CVC screening was impacted by guidelines encouraging pausing CVC screening, patient reluctance, and concerns about exposure. During the recovery period, leadership-driven preventive care prioritization and quality improvement capacity influenced CRC and CVC screening maintenance and recovery. Efforts supporting quality improvement capacity could be key actionable elements for these health centers to endure major disruptions to their care delivery system and to drive rapid recovery.
DOI：
10.3122/jabfm.2020.05.200053
发表时间：
2020-09
期刊：
Journal of the American Board of Family Medicine : JABFM
影响因子：
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作者：
DeVoe JE;Likumahuwa-Ackman SM;Angier HE;Huguet N;Cohen DJ;Flocke SA;Marino M;Gold R
通讯作者：
Gold R