title: Promoting colorectal cancer screening through a new model of delivering rural primary care in the USA: a qualitative study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: University of Nebraska Medical Center Omaha NE 68198 USA. jungyoon.kim@unmc.edu.
authors.forename: Jungyoon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Augusta University, Augusta, GA 30912 USA. luyoung@augusta.edu.
authors.forename: Lufei
authors.initials: L
authors.lastname: Young
authors.affiliation: University of Nebraska Medical Center Omaha NE 68198 USA. Sarbinaz.bekmuratova@unmc.edu.
authors.forename: Sarbinaz
authors.initials: S
authors.lastname: Bekmuratova
authors.affiliation: DePaul University Chicago IL 60614 USA. dschober@depaul.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Schober
authors.affiliation: University of Nebraska Medical Center Omaha NE 68198 USA. hongmeiwang@unmc.edu.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Wang
authors.affiliation: University of Nebraska Medical Center Omaha NE 68198 USA. shreya.roy@unmc.edu.
authors.forename: Shreya
authors.initials: S
authors.lastname: Roy
authors.affiliation: University of Memphis, 3720 Alumni Ave, Memphis,TN, 38152. sbhuran@memphis.edu.
authors.forename: Soumitra S
authors.initials: SS
authors.lastname: Bhuyan
authors.affiliation: University of Nebraska Medical Center Omaha NE 68198 USA. amschumaker@unmc.edu.
authors.forename: Alice
authors.initials: A
authors.lastname: Schumaker
authors.affiliation: University of Nebraska Medical Center Omaha NE 68198 USA. liwuchen@unmc.edu.
authors.forename: Li-Wu
authors.initials: LW
authors.lastname: Chen
mesh_terms: D060866:Accountable Care Organizations; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D015233:Models, Statistical; D009329:Nebraska; D036301:Qualitative Research; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Administrator; Cancer; Health Service reform; Management/Administration; Medical; North America; Nursing; Qualitative Research