Leveraging Primary Care Networks to Increase Breast, Colon Cancer Screening

Engagement between academic medical centers and safety-net primary care practices could help improve screening rates for certain cancers, according to a seven-year project involving the UR CTSI’s Greater Rochester Practice-Based Research Network (GR-PBRN). Annual education about the latest cancer screening guidelines and professional support to help implement evidence-based interventions helped primary care practices boost rates of colorectal and breast cancer screening.

The quality improvement project, which was part of a broader cancer prevention initiative of the New York State Department of Health, involved 12 primary care practices across Rochester, Buffalo and Syracuse. All practices primarily serve disadvantaged populations and are members of Practice-Based Research Networks administered by the University of Rochester Medical Center, the State University of New York (SUNY) Upstate Medical, or SUNY University at Buffalo.

Local implementation of this project was led by GR-PBRN Co-Directors  Gary J. Noronha, M.D., and Carlos M. Swanger, M.D., who are both associate professors of Clinical Medicine at URMC, as well as GR-PBRN Network Coordinator Karen Vitale, M.S.Ed.

Each network provided primary care practices with annual education on updated breast, cervical, and colorectal cancer screening guidelines and ways to improve screening rates. Professional facilitators also helped practices implement evidence-based strategies to increase screening, like offering at-home screening options such as the fecal immunochemical test (FIT) for colorectal cancer.

On average, these supports helped safety-net practices increase screening rates for colorectal and breast cancers, but not cervical cancer. Over the seven years, average colorectal cancer screening rates climbed significantly from 25 to 48 percent, and average breast cancer screening rates trended upward from 37 to 49 percent. These increases were likely due to the use of mobile mammography units and at-home colorectal cancer screening options.

On the other hand, cervical cancer screening rates dropped from 36 to 31 percent over the seven-year period, possibly because many patients seek cervical cancer screening through obstetric or gynecological specialists. According to project results, communication between specialists and primary care clinics is inconsistent and could be causing some screening-eligible patients to fall through the cracks.

This lack of communications was identified as one of the major barriers to improving cancer screening. While facilitation provided by the project resolved smaller barriers, like workflow inefficiencies and lack of transportation, these larger issues will require sustained attention and resources to overcome.

Despite the COVID-19 pandemic striking the globe in the final year of this project, cancer screening rates at these safety-net primary care practices held fairly steady, with each screening type changing by less than two percent over that year. During the pandemic, the practices relied more heavily on telehealth services, which probably accounts for their ability to maintain cancer screening rates. However, telehealth services are less effective for financially or technologically disadvantaged patients.

Cancer screening saves lives, and this project showed that engagement between academic medical centers and safety-net primary care practices can prevent underserved patients from falling through the cracks. Annual education and professional support helped practices break down barriers to cancer screening and get more patients screened.

Learn more about this project from three papers published in the Journal of Patient-Centered Research and Reviews:

• Improving Cancer Screening Rates in Primary Care via Practice Facilitation and Academic Detailing: A Multi-PBRN Quality Improvement Project, led by Christopher P. Morely, Ph.D., M.A., chair and professor of Public Health and Preventive Medicine at SUNY Upstate Medical University.
• Increasing Breast, Cervical, and Colorectal Cancer Screenings: A Qualitative Assessment of Barriers and Promoters in Safety-Net Practices, led by Laura A. Brady, Ph.D., research assistant professor of Family Medicine at SUNY University at Buffalo.
• Impact of COVID-19 on Screening Rates for Colorectal, Breast, and Cervical Cancer: Practice Feedback From a Quality Improvement Project in Primary Care, led by Laura A. Schad, MPH, executive coordinator of Public Health and Preventive Medicine at SUNY Upstate Medical University.

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The project described in this article utilized the Greater Rochester Practice-Based Research Network, which is supported by the University of Rochester CTSA award number UL1 TR002001 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The Greater Rochester Practice-Based Research Network is a group of 147 separate health care practices that collaborate with each other and with researchers to study clinical and organizational issues in primary care.

Michael Hazard | 11/18/2021

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