br Despite improvements in cancer screening following the im
Despite improvements in cancer screening following the im-plementation of the ACA, many patients had no record of having re-ceived cervical or colorectal cancer screening during the study period. These findings suggest that even with increased access to health in-surance coverage many barriers remain for socioeconomically dis-advantaged patients to receive timely cancer screening. Previous stu-dies (Daly et al., 2015; De Alba and Sweningson, 2006; Ojinnaka et al., 2015) found the following decreased cancer screening rates: low health literacy, English proficiency, and lack of screening infrastructure within the clinic (i.e., do not perform colonoscopy). Future research is needed to understand these and additional barriers and facilitators to cancer screening in CHC populations. Identifying strategies used by high per-forming clinics could be an avenue to develop interventions aimed at promoting cancer screening for socioeconomically disadvantaged po-pulations.
We were unable to assess patient-reported screening histories or screenings received outside of this CHC network and thus our screening rates may be underestimated, particularly for colorectal cancer screening; however, we do not expect that this underestimate would diﬀer by expansion status. The method used to assess screening aligns with the specifications of quality metric reporting systems like Uniform Data System and Meaningful Use (http://www.bphcdata.net/docs/ table_6b.pdf), except our measurement periods were two years in-stead of one year and patients were not required to have a medical visit in the specific A 83 01 to place them in the denominator for that period as long as they had at least one visit in the four-year study period. Thus, the screening rates reported here are not directly comparable to quality metrics or those generated by other methods. Lastly, we did not assess whether or not the National Breast and Cervical Cancer Early Detection Program or the Colorectal Cancer Control Program paid for the cancer screenings, as the information on who received grant monies for these screenings is not available in the ADVANCE dataset. Because we used a 24-month period to assess receipt of FOBT/FIT, the prevalence of up-to-date CRC screening could be overestimated since this is an annual test, however, the objective of this study was to understand the change in prevalence between the pre- and post-periods not to compute the actual yearly prevalence of FOBT/FIT.
Screening prevalence for cervical and colorectal cancer increased post-ACA in both expansion and non-expansion states. Nearly all racial and ethnic groups and insurance types saw improvement, however screening rates remain suboptimal. More eﬀorts are needed to improve receipt of cancer screenings for patients seen in CHCs.
This work was supported by the Agency for Healthcare Research and Quality (grant number R01HS024270) and by the National Cancer Institute (grant numbers R01CA204267 and R01CA181452). The views presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies.
Declaration of Competing Interest
Authors have no competing interests to disclose.
The research reported was conducted with the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) Clinical Research Network, a partner of PCORnet®, the National-Patient Centered Clinical Network, an initiative of the Patient Centered outcomes Research Institute (PCORI). The ADVANCE network is led by OCHIN in partnership with the Health Choice Network, Fenway Health, Oregon Health & Science University, and the Robert Graham Center/HealthLandscape. ADVANCE is funded through PCORI award number [13-060-4716]. The authors also acknowledge the par-ticipation of our partnering health systems.
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