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Research Studies is a compilation of published research articles funded by ´óÏóÊÓƵor authored by ´óÏóÊÓƵresearchers.

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1 to 10 of 10 Research Studies Displayed
Rivera Rivera JN, AuBuchon KE, Schubel LC
Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care.
This study addresses the higher incidence and mortality rates of colorectal cancer (CRC) among Black and Hispanic/Latino populations in the United States. The researchers are conducting a stepped-wedge cluster randomized trial to implement and scale a patient navigation program aimed at improving CRC screening rates in these communities. The trial involves 15 primary care clinics, with a phased introduction of the intervention over six steps, each lasting six months. Following an initial six-month baseline data collection period, clinics are randomized to join the intervention arm in groups of three every six months until all clinics have transitioned. The implementation process includes clinic training and education, electronic health record infrastructure changes, stakeholder relationship building, readiness assessment, and ongoing feedback. Guided by the Practical, Robust Implementation Sustainment Model (PRISM), the study focuses on effectiveness, reach, provider adoption, and implementation aspects. The researchers plan to document adaptations to both the patient navigation intervention and implementation strategies. To promote health equity, the study incorporates multilevel stakeholder input through interviews and a community advisory board, influencing various aspects of the project from planning to dissemination. Provider feedback will include updates on disparities in screening orders and completions. The researchers aim to understand how to tailor a patient navigation program for CRC screening across diverse primary care settings with varying baseline screening rates, payor mix, proximity to specialty care, and patient volume.
AHRQ-funded; HS029807.
Citation: Rivera Rivera JN, AuBuchon KE, Schubel LC . Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care. Implement Sci Commun 2024 Jun 3; 5(1):60. doi: 10.1186/s43058-024-00598-5.
Keywords: Cancer: Colorectal Cancer, Screening, Primary Care, Disparities, Racial and Ethnic Minorities
Campbell KA, Sternberg SB, Benneyan J
Completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care.
This study looked at the completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care, as rectal bleeding is usually the most common presenting symptom of colorectal cancer. This retrospective cohort study was a medical record review of patients aged ≥ 40 with index diagnosis of rectal bleeding at 2 primary practices-an urban academic practice and affiliated community health center-between January 1, 2018, and December 31, 2020. Primary outcomes were percentages of patient cases classified as having completed recommended follow-up workup ("closed loop") vs. not ("open loop"). A total of 837 patients had been coded with rectal bleeding, with 67 excluded leaving 770 patients included. A total of 172 patients (22.3%) failed to undergo timely recommended workup. Reasons for a failed timely workup included the majority not having a procedure ordered, or the procedure was ordered but never scheduled or cancelled and not kept.
AHRQ-funded; HS027282.
Citation: Campbell KA, Sternberg SB, Benneyan J . Completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care. J Gen Intern Med 2024 May; 39(6):985-91. doi: 10.1007/s11606-023-08513-9..
Keywords: Diagnostic Safety and Quality, Screening, Cancer: Colorectal Cancer, Primary Care, Prevention, Cancer
Mojica CM, Gunn R, Pham R
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
This study was conducted to describe clinical workflows for fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in Oregon primary care practices and to identify specific workflow processes that might be associated with higher colorectal cancer (CRC) screening rates. Findings showed that primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Higher CRC screening was associated with having medical assistants discuss and review FIT/FOBT screening and instructions with patients.
AHRQ-funded; HS022981.
Citation: Mojica CM, Gunn R, Pham R . An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees. BMC Cancer 2022 Jan 25;22(1):106. doi: 10.1186/s12885-021-09106-7..
Keywords: Workflow, Screening, Cancer: Colorectal Cancer, Cancer, Primary Care, Vulnerable Populations
Radhakrishnan A, Reyes-Gastelum D, Gay B
Primary care provider involvement in thyroid cancer survivorship care.
While prior research has examined how primary care providers (PCPs) can care for breast and colon cancer survivors, little is known about their role in thyroid cancer survivorship. The purpose of this study was to understand PCP involvement and confidence in thyroid cancer survivorship care. The investigators found that while PCPs reported being involved in long-term surveillance, gaps remained in their confidence in handling survivorship care. They indicated that thyroid cancer survivorship guidelines that delineate PCP roles present one opportunity to increase confidence about their participation.
AHRQ-funded; HS024512.
Citation: Radhakrishnan A, Reyes-Gastelum D, Gay B . Primary care provider involvement in thyroid cancer survivorship care. J Clin Endocrinol Metab 2020 Sep;105(9):e3300-6. doi: 10.1210/clinem/dgaa437..
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer, Primary Care
Davis MM, Gunn R, Pham R
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
This study focused on ways that Medicaid Accountable Care Organizations (ACOs) are implementing interventions with primary care clinics to improve colorectal cancer screening. The researchers conducted a comparative case study of 14 Medicaid ACOs in Oregon and their contracted primary care clinics. They focused on interventions that reduced structural barriers (12 ACOs), delivered provider assessment and feedback (11 ACOs), and provided patient reminders (7 ACOs). There was an unintended consequence of potential exclusion of smaller clinics and metric focus and fatigue.
AHRQ-funded; HS022981.
Citation: Davis MM, Gunn R, Pham R . Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure. Prev Chronic Dis 2019 Aug 15;16:E107. doi: 10.5888/pcd16.180395..
Keywords: Primary Care: Models of Care, Primary Care, Screening, Colonoscopy, Cancer: Colorectal Cancer, Cancer, Quality Improvement, Quality of Care, Care Coordination, Patient-Centered Healthcare
Bravo RI, Kietzman KG, Toy P
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
This paper describes the Healthy Aging Partnerships in Prevention Initiative (HAPPI) which aims to increase colorectal cancer screening and other preventive services among underserved Latinos and African-Americans in South Los Angeles who are 50 years and older. It uses an evidence-based model (SPARC) to leverage existing resources and has multi-sectoral partnerships among different agencies, community health centers (CHCs), and a university. The authors engaged five CHCs in quality improvement activities and eight non-governmental organizations in networking and programming to increase awareness of these preventive services.
AHRQ-funded; HS010858.
Citation: Bravo RI, Kietzman KG, Toy P . Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project. Salud Publica Mex 2019 Jul-Aug;61(4):427-35. doi: 10.21149/9450..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Primary Care: Models of Care, Primary Care, Elderly, Racial and Ethnic Minorities, Vulnerable Populations, Patient-Centered Healthcare
Kistler CE, Vu M, Sutkowi-Hemstreet A
Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.
This study sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening. While most providers' reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request.
AHRQ-funded; HS019468; HS021133.
Citation: Kistler CE, Vu M, Sutkowi-Hemstreet A . Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening. Int J Gen Med 2018 May 17;11:179-90. doi: 10.2147/ijgm.s153887..
Keywords: Cancer: Colorectal Cancer, Cancer: Prostate Cancer, Primary Care, Practice Patterns, Screening
Kistler CE, Golin C, Sundaram A
Individualized colorectal cancer screening discussions between older adults and their primary care providers: a cross-sectional study.
The aim of this study was to describe colorectal cancer (CRC) screening discussions and explore their associations with patient characteristics and screening intentions. The investigators found that CRC screening discussions varied by type of participant and content. They assert that future work is needed to determine if interventions focused on specific domains alters the appropriateness of participants' colorectal cancer screening intentions.
AHRQ-funded; HS021133.
Citation: Kistler CE, Golin C, Sundaram A . Individualized colorectal cancer screening discussions between older adults and their primary care providers: a cross-sectional study. MDM Policy Pract 2018 Jan-Jun;3(1):2381468318765172. doi: 10.1177/2381468318765172..
Keywords: Cancer: Colorectal Cancer, Shared Decision Making, Elderly, Primary Care, Screening
Halm EA, Beaber EF, McLerran D
Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach.
The researchers assessed associations between primary care provider (PCP) visits and receipt of colorectal cancer (CRC) screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT). They found that patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs.
AHRQ-funded; HS022418.
Citation: Halm EA, Beaber EF, McLerran D . Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach. J Gen Intern Med 2016 Oct;31(10):1190-7. doi: 10.1007/s11606-016-3760-9..


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Keywords: Cancer: Colorectal Cancer, Colonoscopy, Patient-Centered Outcomes Research, Primary Care, Screening
El-Shami K, Oeffinger KC, Erb NL
American Cancer Society colorectal cancer survivorship care guidelines.
Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of colorectal cancer (CRC) survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.
AHRQ-funded; HS020937.
Citation: El-Shami K, Oeffinger KC, Erb NL . American Cancer Society colorectal cancer survivorship care guidelines. CA Cancer J Clin 2015 Nov-Dec;65(6):428-55. doi: 10.3322/caac.21286.
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Keywords: Cancer, Cancer: Colorectal Cancer, Care Coordination, Guidelines, Primary Care

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