Article Figures & Data
Tables
- Table 1.
Characteristics of 23 Primary Care Practices Enrolled in the Practice Facilitation and Academic Detailing Project, 2014–2015
Practice Structure Physicians (n) NPs and/or PAs (n) ADS Attendees (n) FQHC 6–15 ≥2 7 FQHC 2–5 ≥2 9 FQHC 6–15 ≥2 10 FQHC 6–15 ≥2 12 Medical group/health system 2–5 ≥2 9 Medical group/health system 1 ≥2 5 Medical group/health system 1 0 5 Medical group/health system 2–5 0 6 Medical group/health system 1 1 2 Medical group/health system 2–5 1 17 Medical group/health system 6–15 1 20 Medical group/health system 2–5 1 8 Medical group/health system 2–5 1 12 Medical group/health system 2–5 1 9 Non-profit clinic 2–5 ≥2 6 Physician-owned 2–5 ≥2 4 Physician-owned 2–5 ≥2 5 Physician-owned 2–5 ≥2 12 Physician-owned 6–15 ≥2 8 University hospital/clinic 2–5 ≥2 23 University hospital/clinic ≥16 1 9 University hospital/clinic 6–15 0 6 University hospital/clinic 2–5 ≥2 6 ADS, academic detailing session; FQHC, federally qualified health center; NP, nurse practitioner; PA, physician assistant.
- Table 2.
One-Way Repeated Measures Analysis of Variance Comparison of Intervention Cancer Screening Rates Before and After the Intervention at 23 Primary Care Practices Enrolled in the Practice Facilitation and Academic Detailing Project, 2014–2015
Cancer Target Screening Rate Before the Project, Mean (SD) Screening Rate After the Project, Mean (SD) F Statistic (P Value) Breast cancer 36.96% (17.44%) 49.96% (20.62%) 14.17 (0.001) Cervical cancer 35.65% (18.68%) 38.85% (20.34%) 0.998 (NS) Colorectal cancer 32.74% (16.18%) 38.30% (20.80%) 15.740 (0.001) NS, not significant at α = .05; SD, standard deviation.
- Table 3.
Comparison of Average Pre- and Post-Intervention TRANSLATE Model Element Scores at 23 Primary Care Practices Enrolled in Practice Facilitation and Academic Detailing Project, 2014–2015
TRANSLATE Element* Score, Mean (SD)† P Value Before the Intervention After the Intervention Target 2.70 (0.95) 3.00 (1.02) .031 PF1 3.00 (1.00) 3.00 (1.00) PF2 3.33 (0.68) 3.33 (0.68) PF3 2.80 (0.84) 4.00 (0.00) PF4 1.86 (0.69) 2.00 (0.82) .001 Registry and reminder systems 3.22 (0.72) 3.39 (0.48) NS Administrative buy-in 3.15 (0.75) 3.43 (0.59) .029 Network information systems 3.22 (0.86) 3.48 (0.70) .007 Site coordination 3.09 (0.60) 3.22 (0.60) NS Local physician champion 2.74 (1.09) 2.80 (1.02) NS Audit and feedback 2.63 (0.96) 2.85 (0.85) .022 Team approach 2.85 (0.98) 3.11 (1.03) NS Education 2.70 (0.67) 2.91 (0.63) .057 PF1 2.60 (0.22) 2.60 (0.22) PF2 2.17 (0.41) 3.00 (0.00) PF3 3.60 (0.55) 3.60 (0.55) .014 PF4 2.57 (0.54) 2.57 (0.79) Cumulative score 26.28 (3.68) 28.20 (3.56) ≤.001 ↵* Practice facilitator (PF) scores are displayed only for those measures with significant differences between groups (Bonferonni post-hoc analysis).
↵† Scores are based on evaluations by PFs on a scale of 1 (no accomplishment) to 4 (high accomplishment).
NS, not significant at α = .05; SD, standard deviation.
- Table 4.
Spearman Correlation of Screening Rates and Post-Intervention TRANSLATE Element Scores After the Intervention at 23 Primary Care Practices Enrolled in the Practice Facilitation and Academic Detailing Project, 2014–2015
Correlation Coefficient (P Value) Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening Target −0.01 (NS) 0.01 (NS) 0.16 (NS) Registry and reminder systems −0.11 (NS) −0.07 (NS) 0.09 (NS) Administrative buy-in 0.07 (NS) 0.20 (NS) 0.47 (0.024) Network information systems 0.11 (NS) 0.11 (NS) 0.23 (NS) Site coordination 0.47 (0.023) 0.72 (0.001) 0.37 (0.086) Local physician champion −0.06 (NS) −0.04 (NS) −0.19 (NS) Audit and feedback 0.28 (NS) 0.31 (NS) 0.48 (0.022) Team approach 0.20 (NS) 0.50 (0.025) 0.05 (NS) Education 0.42 (0.048) 0.54 (0.014) 0.48 (0.021) Cumulative score 0.28 (NS) 0.49 (0.030) 0.34 (NS) NS, not significant at α = .05.
- Table 5.
Common Barriers and Supports for Increasing Cancer Screening Expressed During Focus Groups and Key Informant Interviews at 23 Primary Care Practices Enrolled in the Practice Facilitation and Academic Detailing Project, 2014–2015
Barriers to Increased Screening Supports of Increased Screening Patient level ∙ Transportation ∙ Education and outreach ∙ Insurance/financial constraints ∙ Case management and follow up ∙ Language/communication issues at the point of care ∙ Lifestyle-amenable screening methods ∙ Comprehension ∙ Reduction of structural barriers ∙ Refusal/noncompliance Staff level ∙ Lack of time ∙ Shared responsibility to discuss and document screening with patients ∙ EHR data errors ∙ Standardized data entry and/or EHR technical assistance ∙ Lack of investment in quality improvement interventions ∙ Performance assessment and feedback ∙ Point-of-care reminders Practice level ∙ Lack of personnel ∙ Quality improvement coaching ∙ Workflow inefficiencies ∙ Workflow assessment and adjustment ∙ EHR data errors and reporting limitations ∙ EHR “workarounds” ∙ Two-way communication with specialists ∙ PCMH certification requirements ∙ EHR technical assistance EHR, electronic health record; PCMH, patient-centered medical home.
