# Predictors of Colorectal Cancer Screening Rates in Federally Qualified Health Centers: Explicating Organizational Level Factors

## TL;DR

This study explores how organizational factors in health centers affect colorectal cancer screening rates, especially before and during the pandemic.

## Contribution

The study identifies organizational-level factors influencing CRC screening rates in FQHCs, particularly the role of PCMH recognition and chronic disease management.

## Key findings

- CRC screening rates increased before the pandemic but declined during it and remain below previous levels.
- FQHCs with consistent PCMH recognition had significantly higher screening rates.
- Screening rates were lower in centers with larger Black patient populations and smaller center sizes.

## Abstract

To examine changes in colorectal cancer (CRC) screening rates over time and determine organizational‐level factors influencing these shifts.

This longitudinal study used mixed effects models to analyze data from Federally Qualified Health Centers (FQHCs) in the United States (US). Key organizational‐level factors included Patient‐Centered Medical Home (PCMH) recognition and duration, hypertension and diabetes management, and center‐level characteristics such as racial composition, location, and center volume/size.

This study used Uniform Data System (UDS) data from 2017 to 2022 for US‐based FQHCs receiving full Public Health Service Section 330 grants and reporting CRC screening measures, excluding school‐based centers, US territories, and look‐alike centers.

Among the 1282 FQHCs analyzed, CRC screening rates were increasing before the COVID‐19 pandemic but declined during and remain below pre‐pandemic levels. FQHCs with consistent PCMH recognition reported significantly higher screening rates (β = 8.50, p < 0.001). Screening rates were also positively associated with a higher rate of controlled hypertension (β = 0.354, p < 0.0001) but lower in FQHCs with larger Black patient populations, Southern locations, and smaller center volume/size.

Consistent PCMH recognition and chronic disease management are essential for improving CRC screening rates in FQHCs. By integrating these population health management strategies, FQHCs can proactively address screening disparities. Prioritizing these organizational‐level approaches may strengthen healthcare equity and expand CRC screening for historically marginalized communities.