Practice Adaptive Reserve and Colorectal Cancer Screening Best Practices at Community Health Center Clinics in Seven States
Published Date:Dec 18 2014
Pubmed Central ID:PMC4393345
Funding:R01 CA124397/CA/NCI NIH HHS/United States
R01CA124397/CA/NCI NIH HHS/United States
R21 CA136460/CA/NCI NIH HHS/United States
R21CA136460/CA/NCI NIH HHS/United States
U48DP0010909/DP/NCCDPHP CDC HHS/United States
U48DP001903/DP/NCCDPHP CDC HHS/United States
U48DP001911/DP/NCCDPHP CDC HHS/United States
U48DP001924/DP/NCCDPHP CDC HHS/United States
U48DP001934/DP/NCCDPHP CDC HHS/United States
U48DP001936/DP/NCCDPHP CDC HHS/United States
U48DP001938/DP/NCCDPHP CDC HHS/United States
U48DP001944/DP/NCCDPHP CDC HHS/United States
U48DP001946/DP/NCCDPHP CDC HHS/United States
U48DP001949-02/DP/NCCDPHP CDC HHS/United States
UL1 TR000371/TR/NCATS NIH HHS/United States
Enhancing the capability of community health centers to implement best practices may mitigate health disparities. We investigated the association of Practice Adaptive Reserve (PAR) to implementation of Patient Centered Medical Home (PCMH) colorectal cancer (CRC) screening best practices (BPs) at community health center clinics in seven states.
A convenience sample of clinic staff participated in a self-administered online survey. We scored eight PCMH CRC screening BPs as a composite ranging from 0–32. The PAR composite score was scaled from 0 to 1 then categorized into three levels. Multilevel analyses examined the relationship between PAR and self-reported implementation of the PCMH BPs.
Out of 296 respondents, 59% reported 6 or more PCMH BPs at their clinics. The mean PAR score was 0.66 (s.d. 0.18) and PCMH BP mean scores were significantly higher for respondents who reported higher clinic PAR categories. Compared to the lowest PAR level, adjusted PCMH BP means were 25.0 percent higher at the middle PAR level (Difference = 3.2, SE = 1.3, t = 2.44, p = 0.015) and 63.2 percent higher at the highest PAR level (Difference = 8.0, SE = 1.9, t = 4.86, p < 0.0001).
Higher Adaptive Reserve, as measured by the PAR score, is positively associated with self-reported implementation of PCMH CRC screening BPs by clinic staff. Future research is needed to determine PAR levels most conducive to implementing CRC screening and to develop interventions that enhance PAR in primary care settings.
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