December 07, 2017
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Grant program boosts colon cancer screening in low-income areas

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Kara Riehman, PhD
Kara Riehman

The American Cancer Society’s Community Health Advocates Implementing Nationwide Grants for Empowerment and Equity (CHANGE) grant program effectively increased colorectal cancer screening rates in health centers that serve low-income and underserved communities, according to new research.

The program was launched in 2013 to address disparities in cancer screening among low-income patients by providing federally qualified health centers (FQHCs) — including primary care systems, faith- and community-based organizations — with grant funding and technical assistance to implement evidence-based interventions to increase screening. The analysis published in the American Journal of Preventive Medicine showed that FQHCs that received grant funding through the program showed significantly greater increases in CRC screening rates than FQHCs that did not receive funding.

“The increase in colorectal cancer screening rates in the funded FQHCs between 2013 and 2014 (8.7 percentage points) outpaced that of all FQHCs nationally, which only increased an average of 2 percentage points,” Kara Riehman, PhD, strategic director of evaluation and research at the American Cancer Society, told Healio Gastroenterology and Liver Disease. “Increases were also larger compared to rates reported in nationally representative samples, for example the Behavioral Risk Factor Surveillance Survey, which showed an increased screening rate of only 1.6 percentage points from 2012 to 2014.”

Riehman and colleagues used data from the Uniform Data System to compare CRC screening rates in 77 of the FQHCs funded between 2013 and 2015 vs. a sample of 77 FQHCs that did not receive funding. The program required funded FQHCs to implement at least one provider-oriented strategy and at least one client-oriented strategy, and most (88.4%) implemented three to five, according to a press release.

The investigators used a genetic matching technique to match FQHC samples, both of which showed significant increases in CRC screening rates over time (P < .001).

However, FQHCs that received grant funding showed significantly greater increases in CRC screening than those that did not receive funding, especially between 2013 and 2014, throughout which funded centers increased screening rates by 8.7%, from 26.4% to 35.1%, while unfunded centers increased screening rates by 2.7%, from 28.5% to 31.2% (P = .004).

Additionally, CRC screening rates at FQHCs that received grant funding increased by 12.7% (from 26.4% to 39.1%) across 3 years, compared with 9% (from 28.5% to 37.5%) at FQHCs that did not receive funding; this difference was not significant.

Riehman and colleagues noted that they found important baseline differences between funded and non-funded centers.

“Funded FQHCs served larger patient populations who were disproportionately members of racial/ethnic minority groups, more likely to have incomes at or below federal poverty guidelines, and more likely to have no health insurance or to be insured through Medicaid or Medicare,” they wrote. “Funded FQHCs lagged behind nonfunded FQHCs on percentage of eligible patients appropriately screened for CRC (26.4% vs. 30.4%).”

Overall, Riehman and colleagues concluded that the findings suggest the CHANGE program effectively promoted improvements in CRC screening rates in funded FQHCs, which improved screening rates faster than FQHCs that did not receive funding.

“Because appropriate screening and diagnostic procedures can prevent colorectal cancer, enhancing access for uninsured, low-income populations can result in a substantial decrease in both cancer incidence and mortality,” Riehman said. – by Adam Leitenberger

Disclosures: The authors report no relevant financial disclosures.