Adapting a Remotely Delivered Patient Navigation Program for Colorectal Cancer Screening in Primary Care: Important Considerations for Rural Contexts.

Introduction: Colonoscopy is a critical component of colorectal cancer (CRC) screening and patient navigation (PN) improves colonoscopy completion. A lay navigator remotely providing navigation across rural primary care organizations (PCOs) could increase PN access. In preparation for the Colonoscopy Outreach for Rural Communities (CORC) study, we examined partners' perspectives on contextual factors that could influence CORC program implementation, and adaptations to mitigate potential barriers.

Integrating causal pathway diagrams into practice facilitation to address colorectal cancer screening disparities in primary care.

Background: Colorectal cancer (CRC) is the second leading cause of cancer death and the second most common cancer diagnosis among the Hispanic population in the United States. However, CRC screening prevalence remains lower among Hispanic adults than among non-Hispanic white adults. To reduce CRC screening disparities, efforts to implement CRC screening evidence-based interventions in primary care organizations (PCOs) must consider their potential effect on existing screening disparities.

Colonoscopy Outreach for Rural Communities (CORC): A study protocol of a pragmatic randomized controlled trial of a patient navigation program to improve colonoscopy completion for colorectal cancer screening.

Background: Colonoscopy is one of the primary methods of screening for colorectal cancer (CRC), a leading cause of cancer mortality in the United States. However, up to half of patients referred to colonoscopy fail to complete the procedure, and rates of adherence are lower in rural areas.

Objectives: Colonoscopy Outreach for Rural Communities (CORC) is a randomized controlled trial to test the effectiveness of a centralized patient navigation program provided remotely by a community-based organization to six geographically distant primary care organizations serving rural patients, to improve colonoscopy completion for CRC.

Challenges and Approaches to Population Management of Long-Term Opioid Therapy Patients.

Purpose: Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. We identify sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines.

Methods: We examined qualitative data (field notes and postintervention interview and focus group transcripts) from 6 rural and rural-serving primary care organizations with 20 clinic locations enrolled in a study evaluating a practice redesign program to improve opioid medication management for CNCP patients.

Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.

Background: Opioids are more commonly prescribed for chronic pain in rural settings in the USA, yet little is known about how the rural context influences efforts to improve opioid medication management.

Methods: The Six Building Blocks is an evidence-based program that guides primary care practices in making system-based improvements in managing patients using long-term opioid therapy. It was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period.

Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices.

Background: The Six Building Blocks for improving opioid management (6BBs) is a program for improving the management of patients in primary care practices who are on long-term opioid therapy for chronic pain. The 6BBs include building leadership and consensus; aligning policies, patient agreements, and workflows; tracking and monitoring patient care; conducting planned, patient-centered visits; tailoring care for complex patients; and measuring success. The Agency for Healthcare Research and Quality funded the development of a 6BBs implementation guide: a step-by-step approach for independently implementing the 6BBs in a practice.

Staff and Clinician Work-Life Perceptions after Implementing Systems-Based Improvements to Opioid Management.

Background: The Six Building Blocks Program is an evidence-based approach to primary care redesign for opioid management among patients with chronic pain. This analysis assesses the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff.

Methods: Six rural and rural-serving primary care organizations with 20 clinic locations implemented the Six Building Blocks with support from a practice facilitator, clinical experts, and an informatics specialist.

Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing.

Purpose: Six key elements of opioid medication management redesign in primary care have been previously identified. Here, we examine the effect of implementing these Six Building Blocks on opioid-prescribing practices.

Methods: Six rural-serving organizations with 20 clinic locations received support for 15 months during the period October 2015 to May 2017 to implement the Six Building Blocks.

Primary Care Clinic Re-Design for Prescription Opioid Management.

Background: The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain.

Methods: Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations.

Development of a Culturally-Adapted Graphic Novella about Emergency Communication: Collaborations with a Limited English Speaking Chinese Immigrant Community.

Bystander CPR doubles survival from cardiac arrest but limited English proficient (LEP) individuals face barriers calling 911 and performing CPR. Previous training increases the chance that an individual will perform CPR, yet access to classes in non-English speaking populations is limited. We used a cultural adaptation approach to develop a graphic novella for Chinese LEP immigrants about how to call 911 and perform bystander CPR.

Protocol: simulation training to improve 9-1-1 dispatcher identification of cardiac arrest.

Background: 9-1-1 dispatchers are often the first contact for bystanders witnessing an out-of-hospital cardiac arrest. In the time before Emergency Medical Services arrives, dispatcher identification of the need for, and provision of Telephone-CPR (T-CPR) can improve survival. Our study aims to evaluate the use of phone-based standardized patient simulation training to improve identification of the need for T-CPR and shorten time to start of T-CPR instructions.

Medical interpreters and bilingual school staff: Potential disaster information conduits?

Objectives: Dissemination of trusted disaster information to limited English proficient (LEP) communities may mitigate the negative effects these higher risk communities experience in disasters. For immigrant communities, disaster messages may be perceived with skepticism, and fear of public officials may affect compliance with disaster messages. This study explores whether medical interpreters (MIs) and bilingual school staff (BSS) are already informal information sources for LEP communities, and could their connection to both public service organizations and LEP communities make them ideal efficient, trusted disaster information conduits for LEP communities.

Changes to DA-CPR instructions: can we reduce time to first compression and improve quality of bystander CPR?

Introduction: Dispatcher-assisted CPR (DA-CPR) can increase rates of bystander CPR, survival, and quality of life following cardiac arrest. Dispatcher protocols designed to improve rapid recognition of arrest and coach CPR may increase survival by (1) reducing preventable time delays to start of chest compressions and (2) improving the quality of bystander CPR.

Methods: We conducted a randomized controlled trial comparing a simplified DA CPR script to a conventional DA CPR script in a manikin cardiac arrest simulation with lay participants.

Delivering 9-1-1 CPR Instructions to Limited English Proficient Callers: A Simulation Experiment.

Having 911 telecommunicators deliver CPR instructions increases cardiac arrest survival, but limited English proficiency (LEP) decreases the likelihood callers will perform CPR and increases time to first compression. The objective of our study was to assess which 9-1-1 CPR delivery modes could decrease time to first compression and improve CPR quality for LEP callers. 139 LEP Spanish and Chinese speakers were randomized into three arms: receiving CPR instructions from a 9-1-1 telecommunicator (1) with telephone interpretation, (2) using alternative, simple ways to rephrase, or (3) who strictly adhered to protocol language.

Hypertension identification via emergency responders: a randomized controlled intervention study.

Objective: The objective was to test the effectiveness of a mail campaign that included blood pressure (BP) measurements from patients treated by emergency medical technicians (EMTs) to motivate them to (re)check their BP at a fire station. The mailing used a 2×2 research design tailoring on risk and source personalization.

Method: In this randomized controlled trial, participants were randomized into a control group or one of four experimental groups.

Feasibility of partnering with emergency medical services to identify people at risk for uncontrolled high blood pressure.

Introduction: Uncontrolled high blood pressure (HBP) is a significant health problem and often goes undetected. In the prehospital care-delivery system of 9-1-1 emergency medical services (EMS) calls, emergency medical technicians (EMTs) routinely collect medical information, including blood pressure values, that may indicate the presence of chronic disease. This information is usually archived without any further follow-up.

Diffusion of cardiopulmonary resuscitation training to chinese immigrants with limited english proficiency.

Cardiopulmonary resuscitation (CPR) is an effective intervention for prehospital cardiac arrest. Despite all available training opportunities for CPR, disparities exist in participation in CPR training, CPR knowledge, and receipt of bystander CPR for certain ethnic groups. We conducted five focus groups with Chinese immigrants who self-reported limited English proficiency (LEP).