RESUMEN
INTRODUCTION: Despite the known benefits of colorectal cancer (CRC) screening, rural areas have consistently reported lower screening rates than their urban counterparts. Alternative healthcare delivery models, such as accountable care organizations (ACOs), have the potential to increase CRC rates through collaboration among healthcare providers with the aim of improving quality and decreasing cost. However, researchers have not sufficiently explored how this innovative model could influence the promotion of cancer screening. The purpose of the study was to explore the mechanism of how CRC screening can be promoted in ACO-participating rural primary care clinics. METHODS: The study collected qualitative data from in-depth interviews with 21 healthcare professionals employed in ACO-participating primary care clinics in rural Nebraska. Participants were asked about their views on opportunities and challenges to promote CRC screening in an ACO context. Data were analyzed using a grounded theory approach. RESULTS: The study found that the new healthcare delivery model can offer opportunities to promote cancer screening in rural areas through enhanced electronic health record use, information sharing and collaborative learning within ACO networks, use of standardized quality measures and performance feedback, a shift to preventive/comprehensive care, adoption of team-based care, and empowered care coordinators. The perceived challenges were found in financial instability, increased staff workload, lack of provider training/education, and lack of resources in rural areas. CONCLUSIONS: This study found that the innovative care delivery model, ACO, could provide a well-designed platform for promoting CRC screening in rural areas, if sustainable resources (eg finance, health providers, and education) are provided. This study provides 'practical' information to identify effective and sustainable intervention programs to promote preventive screening. Further efforts are needed to facilitate delivery system reforms in rural primary care, such as improving performance evaluation measures and methods.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/estadística & datos numéricos , Modelos Estadísticos , Servicios de Salud Rural/organización & administración , Población Rural/estadística & datos numéricos , Organizaciones Responsables por la Atención , Anciano , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer/economía , Femenino , Humanos , Masculino , Área sin Atención Médica , Persona de Mediana Edad , Nebraska , Investigación Cualitativa , Servicios de Salud Rural/economíaRESUMEN
Disparities in health care and good health between African Americans and other populations while established in the literature are traditionally based on socioeconomic measures of race, income, age, and education (Bailey, 2000; Lillie-Blanton, Brodie, Rowland, Altman and McIntosh, 2000; Ren and Amick, 1996; Watson, 2001; Weinick, Zuvekas, and Cohen, 2000). This study broadens the scope by exploring how sociocultural (poverty, racism, prejudice, and discrimination) and psychosocial factors (perceived health status, the lack of personal efficacy in contributing to decisions about health care. feelings of helplessness, and the lack of trust in the health care providers) relate to health-seeking behaviors of African Americans (Bailey, 1991; Ren and Amick, 1996, Watson, 2001). Interviews were conducted with 111 African American adult patients at a community health center, focusing on health-seeking behaviors, and sociocultural and psychosocial factors. Results suggest that when these negative factors are removed, the health seeking behaviors of African Americans closely mirror the behaviors of the majority population. Subjects did not view themselves in poorer health, fail to seek medical attention when needed, or distrust their primary health care providers. In general, fears associated with health care were attributed to illness rather than health care providers, although a weak linkage was found between patient self-esteem and fear or dislike of future treatment by physicians (adj R2= .362, S.E. =15, F=21, sig. <.001). The study highlights the need for further study in two areas: cultural competency of health care providers, especially those from Asia and Africa who are often assigned to community health centers, and the impact of an accessible community health center on the health seeking behaviors and health status of predominately African American communities.
Asunto(s)
Negro o Afroamericano , Administración de los Servicios de Salud , Aceptación de la Atención de Salud , Adulto , Femenino , Humanos , Entrevistas como Asunto , MasculinoRESUMEN
Interorganizational health care delivery networks have potential for sustaining health services delivery in rural areas faced with economic and demographic challenges. Four Nebraska rural health care delivery networks (Albion-Ord, Blue River Valley, Rural Partners, Inc., and Western Nebraska) were compared to an interorganizational model based on theories of interorganizational relations, exchange, population ecology, and synthesized collaboration. It assumes that outcomes, including effectiveness, are influenced by external and internal factors that are operationalized through external control, technology, structure, and operational process variables. Data were collected by a non-random, two-level cluster mail survey of network members (45/59 = 76.3% response rate). All networks received technical assistance from the Nebraska Office of Rural Health. Networks have formal organization, strategic plans, and official coordinators. Hospital administrators hold most leadership positions; few doctors or citizens are involved. Correlation and multiple regression analysis show partial fit between the research model and study networks. Effectiveness, measure by the gap between best possible and actual practice, increased with network connectivity (r=.36, p<.05), group methods of administrative decision-making (r=.52, p<.001) and sequential pattern of service delivery (r=.39, p<.05). Greater dependence on vertical funding corresponds to greater external control (r=.43, p<.01). The prediction that, as scope narrows, task intensity (r=.56, p<.001), duration (r=.41, p<.01), and task volume (r=.50, p<.01) increase is upheld. Centrality and network size decrease together (r=.43, p<.01) where there is little reliance on vertical sources of funds (r=.36, p<.05). The integrated interorganizational model demonstrates some efficacy for testing potential effectiveness of networks.