The Effect of an EHR Order Set on Cancer Screening Order Rates in Community-Based Health Centers.

Adoption of electronic health record (EHR)-based clinical decision support tools in community-based health centers might increase the provision of indicated cancer screening orders. We examined: (1) if the use of the care gaps smartset (CGS), an EHR tool that expedites ordering care, is associated with colorectal/cervical cancer (CRC/CVC) screening order rates; and (2) how selected implementation strategies, barriers, and facilitators impact CGS use.Within a sequential mixed methods design, we used multivariate regression to assess associations between clinic- and provider-level CGS use and cancer screening order rates.

Insurance Instability Among Community-Based Health Center Patients with Diabetes Post-Affordable Care Act Medicaid Expansion.

Background: To evaluate insurance instability (churn) among adults with diabetes receiving care at community-based health centers (CHCs).

Methods: Retrospective cohort study using patients' electronic health records data for 300,158 adults aged 19 to 64 with ≥3 ambulatory visits between 2014 and 2019 of which 39,542 churned out of insurance. Generalized estimating equation-based (GEE) logistic regression models were fitted to assess the odds of churning.

Medicaid Eligibility Expansion Regardless of Immigration Status and Insurance Coverage Among Latinos Seen in Community Health Centers, 2018‒2023.

To assess whether Latino patients receiving care in community-based health centers (CHCs) in US states that expanded Medicaid eligibility regardless of immigration status to adults 50 years and older had greater insurance coverage after the eligibility amendment compared with states that did not expand eligibility. We performed a retrospective cohort study, using electronic health record data from 40 602 nonpregnant CHC patients aged 50 to 64 years living in states that expanded eligibility (OR, CA) or that did not (AK, CT, IN, MN, MT, NC, NJ, OH, WA) with a visit in both 2018-2019 (before policy change) and 2021-2023 (after policy change). Among Spanish-preferring Latinas, the overall Medicaid-insured difference-in-difference estimate across all 3 years after the amendment was positively moderate (average treatment effect on treated [ATT] = +7.

Residential mobility, neighborhood environment, and diabetes complications among socioeconomically disadvantaged patients in the United States.

Residential mobility can affect health through changes in available resources, social support, or continuity of healthcare. This study sought to understand whether residential mobility and/or change in neighborhood environment among patients with diabetes were associated with diabetes-related complications. This retrospective study used electronic health record data from 19,853 adults aged 18-64 with a diabetes diagnosis seen in 110 safety-net clinics across the United States.

The Effects of Testosterone on Cervicovaginal Cytology in Transgender and Gender-Diverse Individuals.

Background: The Papanicolaou (Papanicolaou) test is an effective and widely used cervical cancer screening procedure. Recommendations for cervical cancer screening do not incorporate patients' gender identities nor gender-affirming hormone statuses in determining screening surveillance intervals and interpreting test results. This study assessed the association between testosterone and rates of abnormal Papanicolaou specimens and specimen adequacy by comparing testosterone-associated Papanicolaou specimens and nontestosterone Papanicolaou specimens among transgender and gender-diverse (TGD) patients.

Diabetes Complications Among Community-Based Health Center Patients with Varying Multimorbidity Patterns.

Background: Multimorbidity with diabetes mellitus (DM and ≥ 1 chronic disease) presents challenges to maintaining adequate DM control.

Objective: This study evaluates the risk of DM-related complications associated with various multimorbidity/DM patterns for patients seen in community-based health centers (CHCs).

Design: Retrospective cohort study from the ADVANCE multi-state practice-based clinical data network.

The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings.

Objective: This study evaluates whether gaining Medicaid following the Affordable Care Act (ACA) expansion led to changes in the rate of acute diabetes complications diagnosed in primary care settings, relative to in inpatient, emergency department (ED), or urgent care (UC) settings.

Methods: This retrospective cohort study used Medicaid administrative claims data linked to electronic health records for 3767 patients, aged 19 to 64 years, who experienced acute preventable complications of diabetes between 2014 and 2019 diagnosed in inpatient, ED, UC, or primary care settings in the state of Oregon. These patients were classified as either continuously Medicaid-insured or having gained Medicaid.

Impacts of pragmatic implementation science in a primary care laboratory.

The Implementation Science Centers in Cancer Control (ISC3) initiative, funded by the National Cancer Institute, called for the development of implementation laboratories to bolster implementation science, create research-ready environments, and expedite adoption and implementation of evidence-based interventions (EBIs) into practice. The Building Research in Implementation and Dissemination to close Gaps and achieve Equity in Cancer Control (BRIDGE-C2) Center is one of seven ISC3 centers. BRIDGE-C2 aims to identify strategies to improve implementation of cancer prevention EBIs and conduct research / develop pragmatic methods to tailor, enhance, and support the adoption and sustainability of these strategies; advance implementation science; and build capacity and training opportunities.

Social risk factors and cancer prevention care among patients in community health-care settings.

Background: Social risks are negatively associated with receipt of cancer preventive care. As knowledge is lacking on the pathways underlying these associations, we investigated associations between patient-reported social risks and colorectal cancer (CRC), cervical cancer, and breast cancer screening order provision and screening completion.

Methods: This study included patients eligible for CRC, cervical cancer, or breast cancer screening at 186 community-based clinics between July 1, 2015, and February 29, 2020.

Association Between a Mother's Cervical Cancer Screening and Child's Human Papillomavirus (HPV) Vaccination Status.

Objectives: To investigate the association between maternal cervical cancer (CC) screening status and child human papillomavirus (HPV) vaccination uptake. To understand if child sex or social deprivation index (SDI) modify this association.

Methods: We used a national cohort of children linked to at least one parent using electronic health record (EHR) data from a network of community health centers across the United States.

Achieving Cancer Equity by Improving Health Insurance Access for All Latinos.

Cancer is the top leading cause of death among Latino people. Lack of health insurance is a significant contributor to inadequate cancer detection and treatment. Despite healthcare policy expansions such as the Affordable Care Act, Latino people persistently maintain the highest uninsured rate among any ethnic and racial group in the US, especially among Latino individuals who are immigrants or part of a mixed immigration status household.

Community Health Centers Uptake of Telemedicine During the COVID-19 Pandemic: Trends, Barriers, and Successful Strategies.

Objective: To describe telemedicine use patterns and understand clinic's approaches to shifting care delivery during the COVID-19 pandemic.

Methods: We used electronic health record data from 203 community health centers across 13 states between 01/01/2019 and 6/31/2021 to describe trends in telemedicine visit rates over time. Qualitative data were collected from 13 of those community health centers to understand factors influencing adoption and implementation of telemedicine.

Applying Machine Learning Techniques to Implementation Science.

Machine learning (ML) approaches could expand the usefulness and application of implementation science methods in clinical medicine and public health settings. The aim of this viewpoint is to introduce a roadmap for applying ML techniques to address implementation science questions, such as predicting what will work best, for whom, under what circumstances, and with what predicted level of support, and what and when adaptation or deimplementation are needed. We describe how ML approaches could be used and discuss challenges that implementation scientists and methodologists will need to consider when using ML throughout the stages of implementation.

Impact of Healthcare Location Concordance on Receipt of Preventive Care Among Children Whose Parents have a Substance Use and/or Mental Health Diagnosis.

Aims: Children of parents with substance use and/or other mental health (SU/MH) diagnoses are at increased risk for health problems. It is unknown whether these children benefit from receiving primary care at the same clinic as their parents. Thus, among children of parents with >1 SU/MH diagnosis, we examined the association of parent-child clinic concordance with rates of well-child checks (WCCs) and childhood vaccinations.

Differences in up-to-date colorectal and cervical cancer screening rates by ethnicity and preferred language: An analysis across patient-, clinic-, and area-level data sources.

Research Objective: There is interest in using clinic- and area-level data to inform cancer control, but it is unclear what value these sources may add in combination with patient-level data sources. This study aimed to investigate associations of up-to-date colorectal and cervical cancer screenings at community health centers (CHCs) with ethnicity and language variables at patient-, clinic-, and area-levels, while exploring whether patient-level associations differed based on clinic-level patient language and ethnicity distributions.

Study Design: This was a cross-sectional study using data from multiple sources, including electronic health records, clinic patient panel data, and area-level demographic data.

A Scoping Literature Review on Evidence-Based Strategies to Increase Cervical Cancer Screening.

Previous reviews of strategies to increase cervical cancer screening are more than 10 years old, the U.S. continues to fall short of the Healthy People 2030 cervical cancer screening goal, and guidelines were revised in 2018, therefore an updated review of the existing literature is needed.

Analgesic methadone prescribing in community health centers among patients with chronic pain.

Objective: To examine analgesic methadone prescriptions among community health center (CHC) patients with chronic pain.

Design: Observational; two cross-sectional periods.

Setting: Oregon and California CHCs.

Impact of Health Insurance Patterns on Chronic Health Conditions Among Older Patients.

Background: Patients have varying levels of chronic conditions and health insurance patterns as they become Medicare age-eligible. Understanding these dynamics will inform policies and reforms that direct capacity and resources for primary care clinics to care for these aging patients. This study 1) determined changes in chronic condition rates following Medicare age eligibility among patients with different insurance patterns and 2) estimated the number of chronically ill patients who remain inadequately insured post-Medicare eligibility among patients receiving care in community health centers.

Diabetes and Hypertension Prevention and Control in Community Health Centers: Impact of the Affordable Care Act.

Access to care significantly improved following the implementation of the Patient Protection and Affordable Care Act. Since its implementation, the number of uninsured Americans has significantly decreased. Medicaid expansion played an important role in community health centers, who serve historically marginalized populations, leading to increased clinic revenue, and improved access to care.

Uptake of a Cervical Cancer Clinical Decision Support Tool: A Mixed-Methods Study.

Objectives: Clinical decision support (CDS) tools that provide point-of-care reminders of patients' care needs may improve rates of guideline-concordant cervical cancer screening. However, uptake of such electronic health record (EHR)-based tools in primary care practices is often low. This study describes the frequency of factors associated with, and barriers and facilitators to adoption of a cervical cancer screening CDS tool (CC-tool) implemented in a network of community health centers.

Advancing health equity through implementation science: Identifying and examining measures of the outer setting.

Background: Implementation science (IS) could accelerate progress toward achieving health equity goals. However, the lack of attention to the outer setting where interventions are implemented limits applicability and generalizability of findings to different populations, settings, and time periods. We developed a data resource to assess outer setting across seven centers funded by the National Cancer Institute's IS Centers in Cancer Control (ISC) Network Program.