||3P50CA244433-01S2 Interpret this number
||Harvard School Of Public Health
||The Implementation Science Center for Cancer Control Equity: Electronic Screening Tools Supplement
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 . 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.
None. See parent grant details.