Grant Number:	3P50CA244433-01S2 Interpret this number
Primary Investigator:	Emmons, Karen
Organization:	Harvard School Of Public Health
Project Title:	The Implementation Science Center for Cancer Control Equity: Electronic Screening Tools Supplement
Fiscal Year:	2020

COVID-19 has thrown the entire US healthcare system into chaos. In Boston, a key hot spot, large hospitals are on the front-lines of pandemic response, offering emergent care for which they will be reimbursed. These hospital systems also have other resources (e.g. donors, real estate holdings) to mitigate the COVID-related financial impact. In contrast, Massachusetts’ (MA) community health centers (CHCs), which care for 50% of Boston residents and 20% of all MA residents, have primarily one source of revenue—reimbursement for primary care. MA CHCs, which serve as the Implementation Laboratory (I-Lab) for our P50 Implementation Science Center for Cancer Control Equity (ISCCCE), have been financially devastated by the pandemic. Our state-wide stay-at-home order (implemented 3/24/20 and ongoing) has brought primary care delivery nearly to a halt. Net patient service revenue in CHCs is down by 50-70%, with lost revenue estimates of close to $150M in the first 12 weeks of the pandemic; over 3,000 CHC staff have been laid off. In the post-pandemic era, CHCs will be struggling to operate with fewer staff and to provide care to patients who themselves have faced job loss and other hardships. Challenges in ramping services back up will further limit CHCs’ financial recovery and the health of the communities they serve. At the same time, there will be a significant back-log of cancer screening needs -- service delivery that will be key to increasing revenue flow and reducing disparities. It will be particularly critical for CHCs to have efficient strategies that, even with reduced staffing, can help them efficiently meet their patients’ cancer screening needs. Early detection through timely mammography and colorectal cancer screening is critical for reducing mortality, but there are important disparities in access and stage at diagnosis and mortality [1, 2]. For example, racial/ ethnic minorities are half as likely as Whites to receive timely follow-up after abnormal mammograms [2-6]. In a post-COVID era, the factors that drive disparities in cancer screening outcomes will likely be exacerbated and lead to further racial, ethnic, and economic disparities without strategies that explicitly address these inequities [7]. Population health management systems may help close care gaps [8, 9], as they integrate patient data from diverse sources to quickly show where follow-up is needed [7, 10, 11]. Such systems may be particularly critical to helping CHCs to rapidly identify and triage screening needs and follow-up, allowing efficient management of care needs despite their staffing and financial stressors. The key issue motivating this supplement is the critical need to help CHCs in the post-COVID era to efficiently provide quality care in ways that will meet patient needs and mitigate further disparities, while at the same time generating revenue. This supplement will provide critical support needed by CHCs to continue to participate as an active partner in ISCCCE, and will contribute to their overall survival. We will to develop and evaluate new electronic tools and implementation supports to increase CHCs’ ability to efficiently provide fecal immunochemical testing (FIT) and mammography screening with timely follow-up, which will contribute to CHCs’ financial health and survival. The Implementation Science Center for Cancer Control Equity (ISCCCE) is an NCI P50 center. The ISCCCE Implementation Lab includes 30 CHCs that use a common population health management platform, the Data Reporting and Visualization System (DRVS), which integrates clinical, referral, and billing data and includes functions for triggering screening referrals. However, the system does not include any tools for: 1) tracking screening that has been ordered but not completed; or 2) tracking follow-up of abnormal results—these activities are done manually. New tools could streamline the labor-intensive and time-sensitive work of manual tracking and follow up that will be particularly crucial post-COVID, with limited staffing, screening back-logs, and the urgent need to create efficiencies in care delivery. The goal of this supplement is to develop and implement population management tools that will build critical infrastructure to allow CHCs to efficiently provide cancer screening during pandemic recovery. We aim to develop and evaluate a resource-appropriate, technology-driven intervention to improve completion of FIT and mammography and timeliness of diagnostic resolution in the post-COVID era.





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