BRIDGE-C2 Center Pilot Studies
BRIDGE-C2 Center pilots are identified based on surveillance data, Laboratory priorities, follow-up from existing pilots, potential for cross-center application, and gaps in the literature. Pilots are aligned with the scientific mission of the Center, and follow a cross-Core start-up process to establish communication and regulatory documents, and continue into a pilot maintenance phase with data collection, analysis, and regular project management meetings.
Pilot Studies in Progress
Gender Expansive Cancer Health
Gender expansive individuals face disparities in receiving guideline-concordant care. The aim of this pilot is to use EHR data to examine (1) cervical cancer screening and results, and (2) tobacco use status and cessation services, among gender expansive patients compared to cis-gendered patients seen in Oregon Health & Science University primary care clinics.
Colorectal Cancer Screening Delays in LGBTQ Populations
PI: Matthew Jones, MS; Rachel Gold, PhD
This pilot examines the rates of on-time colorectal cancer (CRC) screening by sexual orientation and gender identity. This pilot will assess disparities in on-time CRC screening for LGBTQ patients.
Cutaneous melanoma is a potentially life-threatening form of skin cancer that is increasing in incidence and is the fifth most common invasive cancer in the United States. The early detection of melanoma through simple, noninvasive screening practices has a considerable potential to reduce the burden of this disease. In Oregon, there are few dermatologists in the areas of highest incidence, so primary care providers are in a unique position to recognize and treat or triage skin cancers. This two-phase, mixed-methods pilot will implement and assess a multi-component intervention (training, dermatoscope, workflow redesign) to improve skin cancer screening in primary care.
Release Change Notes
PI: Rachel Gold, PhD
Many implementation strategies use the EHR to promote guideline-concordant cancer screening, but our previous research has shown that providers and clinics may not be aware of new tools in the EHR. This pilot is developing and evaluating process models and materials to improve the communication to members in the OCHIN Implementation Laboratory about updates and changes to the electronic health record (EHR).
Electronic Health Record (EHR)-based tools offer promising strategies for supporting the provision of guideline-based care. This study measures practice staff’s EHR efficiency / competency and skills prior to implementing EHR-based tools to identify the type and amount of EHR optimization training is necessary before new EHR-based tools may be adopted. We identified patterns of strength and deficiencies at both clinician and clinic levels using latent class analysis. We also developed a blueprint to inform strategies for tailoring EHR training and are testing the utility of EHR efficiency score as a predictor of EHR tool adoption.
Cancer Preventive Care During- and Post-COVID-19 Pandemic
This mixed-methods pilot explores how the COVID-19 pandemic is impacting cancer screening and prevention among patients receiving care in Community Health Centers (CHCs) in the BRIDGE-C2 Laboratory. Specifically, we are assessing how cancer prevention was delivered during the pandemic, impacts of delayed screenings and prevention, effectiveness of new care delivery methods (telemedicine, mobile vans). We recruited 13 clinics and conducted 29 interviews with clinic staff. We found that clinics that were successful at rapidly adopting telemedicine had buy-in from health system and clinic leadership, experience with telemedicine in the past and were strong at conducting Quality Improvement initiatives. Cancer preventive care sharply decreased at the onset of the pandemic and slowly climbed back to baseline rates. Clinics reported hospital closures, limited staff capacity and patient reluctance to visit in-person as barriers to cancer preventive care. Strategies to continue delivering/resuming care included: patient outreach, mobile vans and home visits and curbside services.
Completed Pilot Studies
Precision Implementation Methods
Using an Electronic Health Record (EHR)-based decision support tool designed to improve cervical cancer screening and prevention, this pilot developed models to identify practice and provider characteristics that predict adoption of innovative implementation strategies. Our analysis included two EHR-based tools: a health insurance support tool and a cervical cancer screening tool. We compiled 25 EHR clinic-level indicators to predict adoption and sustainability of these tools. Using machine learning modeling, we found good and outstanding predictive performance for the insurance tool and cervical cancer screening tool, respectively. Predictors included clinical- (e.g., number of encounters) and patient-related (e.g., % female patients) indicators.
Cervical Cancer Screening Tool
Though rates of cervical cancer (CC) screening are on the rise, this improvement is not equitably distributed among patients. Using a mixed-methods approach, this pilot addressed a gap in cancer screening and prevention by identifying the factors that impacted adoption of a health information technology (HIT)-based decision support tool, an implementation strategy commonly used in real-world CHCs to increase guideline-concordant care. The study found that 46% of eligible clinics used the tool, and tool users had greater rates of up-to-date screening and abnormal results. Qualitative results showed a lack of knowledge of the tool's existence and lack of formal training.
BRIDGE 2 Cessation
Despite overall reductions in adult tobacco use rates in the United States, tobacco use remains the leading preventable cause of death in the US; and significant smoking-related disparities persist among low socioeconomic populations. This mixed-methods study examined rates of use of an Electronic Health Record (EHR)-based tool for referral to the state Quitline, and patient acceptance and denial of the referral within clinics in the BRIDGE-C2 Laboratory. The study found that the eReferral system was not used frequently by clinics that had access to the system. We found that very few patients who were current smokers were being offered referral to the Quitline using the eReferral system. Clinic staff attributed this to lack of training and knowledge of how the system worked. We identified implementation strategies that should improve tool adoption.
ASCEND - Adaptation Implementation Tracking Method
Adapting clinical interventions to meet individual primary care settings' needs can enhance the interventions' uptake. This research tested strategies for helping Community Health Centers (CHCs) systematically identify and take action on social determinants of health.
Cancer Registry Linkage
This study assessed the completeness and accuracy of EHR cancer survivor data by linking Cancer Registry data from California, Washington, and Oregon to OCHIN Implementation Laboratory data.
This study aimed to describe the longitudinal trends in the delivery of three cancer preventive care metrics and define and compare Community Health Centers (CHCs) with high vs low cancer preventive care performance.