title: Practice adaptive reserve and colorectal cancer screening best practices at community health center clinics in 7 states.
abstract: BACKGROUND
  Enhancing the capability of community health centers to implement best practices (BPs) may mitigate health disparities. This study investigated the association of practice adaptive reserve (PAR) with the implementation of patient-centered medical home (PCMH) colorectal cancer (CRC) screening BPs at community health center clinics in 7 states.
  
  
  METHODS
  A convenience sample of clinic staff participated in a self-administered, online survey. Eight PCMH CRC screening BPs were scored as a composite ranging from 0 to 32. The PAR composite score was scaled from 0 to 1 and then categorized into 3 levels. Multilevel analyses examined the relation between PAR and self-reported implementation of PCMH BPs.
  
  
  RESULTS
  There were 296 respondents, and 59% reported 6 or more PCMH BPs at their clinics. The mean PAR score was 0.66 (standard deviation, 0.18), and the PCMH BP mean scores were significantly higher for respondents who reported higher clinic PAR categories. In comparison with the lowest PAR level, adjusted PCMH BP means were 25.0% higher at the middle PAR level (difference, 3.2; standard error, 1.3; t = 2.44; P = .015) and 63.2% higher at the highest PAR level (difference, 8.0; standard error, 1.9; t = 4.86; P < .0001).
  
  
  CONCLUSIONS
  A higher adaptive reserve, as measured by the PAR score, was positively associated with self-reported implementation of PCMH CRC screening BPs by clinic staff. Future research is needed to determine the PAR levels most conducive to implementing CRC screening and to develop interventions that enhance PAR in primary care settings.
authors.affiliation: Department of Medicine, Virginia Commonwealth University, Richmond, Virginia; Department of Health Services, University of Washington, Seattle, Washington.
authors.forename: Shin-Ping
authors.initials: SP
authors.lastname: Tu
authors.forename: Vicki M
authors.initials: VM
authors.lastname: Young
authors.forename: Letoynia J
authors.initials: LJ
authors.lastname: Coombs
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Williams
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Kegler
authors.forename: Amanda T
authors.initials: AT
authors.lastname: Kimura
authors.forename: Betsy C
authors.initials: BC
authors.lastname: Risendal
authors.forename: Daniela B
authors.initials: DB
authors.lastname: Friedman
authors.forename: Beth A
authors.initials: BA
authors.lastname: Glenn
authors.forename: Debbie J
authors.initials: DJ
authors.lastname: Pfeiffer
authors.forename: Maria E
authors.initials: ME
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003151:Community Health Centers; D003625:Data Collection; D055088:Early Detection of Cancer; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D014481:United States; D055815:Young Adult
keywords: adaptive reserve; best practices; disparities; implementation; primary care