ORIGINAL RESEARCH
Amanda F. Petrik; Jennifer Coury; Jean Hiebert Larson; Brittany Badicke; Gloria D. Coronado; Melinda Davis
Corresponding Author: Amanda Petrik, PhD; Center for Health Research - Kaiser Permanente Northwest.
Email: Amanda.F.Petrik@kpchr.org
DOI: 10.3122/jabfm.2022.220216R1
Keywords: Cancer Screening, Colonoscopy, Colorectal Cancer, Electronic Health Records, Oregon, Population Health Management
Dates: Submitted: 06-17-2022; Revised: 08-08-2022; Accepted: 08-11-2022
Status: In production for ahead of print.
INTRODUCTION: Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents despite the availability of effective screening methods. Outreach activities can improve CRC screening rates but rely on accurate identification of patients due for screening. We report on data challenges in rural clinics and Medicaid health plans in Oregon in identifying patients eligible for CRC screening, in a large project implementing mailed fecal testing (FIT) and patient navigation.
METHODS: We analyzed data from clinic intake surveys and administrative claims. Clinics were asked to identify total population numbers relevant to CRC screening and follow-up. Health plans also identified enrollees eligible for CRC screening in Spring, 2021. Clinic staff validated patient lists for eligibility using their electronic health records (EHR).
RESULTS: EHR features varied across the 28 responding clinics. Among the 28 responding clinics, 21 were able to report their Medicaid population (75%), 19 reported the number of patients aged 50-75 (68%) and the number screened for CRC in the last year (68%). Only 8 (29%) were able to report screening details such as number screened by FIT and 9 were able to report on patients with an abnormal FIT or colonoscopy completed after FIT (32%). Health plans had challenges properly identifying where enrollees received care and had missing data for race and ethnicity (range 22-34% unknown race, <1%-24% unknown ethnicity).
CONCLUSION: Most rural primary care clinics and Medicaid health plans experienced challenges identifying the population due for a CRC screening outreach program. Better EHR functionality and data reporting capabilities could help rural clinics apply population-based strategies and ultimately attenuate disparities in cancer screening and follow-up.