Community Health Centers' Performance in Cancer Screening and Prevention

Abstract

Introduction: Little is known about what clinic-level factors differentiate community health centers that achieve high performance on cancer-preventive care metrics. This study aims to describe the longitudinal trends in the delivery of 3 cancer-preventive care metrics (cervical and colorectal cancer screenings and tobacco-cessation intervention) and define and compare community health centers with high cancer-preventive care performance with those with low cancer-preventive care performance.

Methods: This observational study used 2012-2019 community health center data (N=933) from the Uniform Data System. High/low performance was based on Healthy People 2020 targets and sample distribution. For each cancer-preventive care metric, the percentage of community health centers that met high (≥70.5% at cervical or colorectal cancer screening or >80% tobacco-cessation intervention) and low thresholds at 1, 2, and all the 3 screenings was estimated. Multivariable generalized estimating equations logistic regression modeling was used to assess the community health center‒level factors associated with screening performance.

Results: The community health centers' performance for tobacco-cessation intervention remained at ≥80%, with a small increase over time. Performance for cervical cancer screening remained unchanged with about 50% of patients screened. Colorectal cancer screening performance increased from around 30% in 2012 to 44% in 2019. Very few community health centers reached high performance (3%) in all the 3 indicators, and 13% of community health centers were high in any 2 of the outcomes in 2019. Higher patient volume, a greater proportion of Hispanic patients, fewer uninsured patients, and community health centers located in the Northeast region were associated with high performance in 2019.

Conclusions: Very few community health centers meet all Healthy People 2020 goals in cancer screenings and may struggle to achieve the 2030 goals. Very few indicators differentiated high performers from low performers.

Figure 1.

Trends in the performance of cancer preventive care metrics across 933 U.S. community health centers, 2012‒2019. Notes: Colorectal cancer screening is the percentage of patients aged 50‒75 years with a medical visit in reporting year who had appropriate screenings for colorectal cancer (e.g., FOBT, FIT, colonoscopy) following the USPSTF recommendation. Cervical cancer screening is the percentage of women aged 21‒64 years who had cervical cytology performed every 3 years, or aged 30‒64 years who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years. Tobacco cessation intervention is the percentage of patients aged 18 years and older who were screened for tobacco use one or more times within a 24-month period and who received tobacco cessation intervention if identified as a tobacco user. FOBT, fecal occult blood test; FIT, fecal immunochemical test; USPSTF, U.S. Preventive Services Task Force.