A Case Study: SWOT Analysis to Improve CRC Screening at the Suffolk County Community Health Centers (con't)

Strengths

Staff and Health Service Delivery
Strengths were classified within the areas of staff and patient care and the tests themselves. Participants in the SWOT analysis at each of the centers felt they had dedicated and motivated clinical staff who were knowledgeable about CRC. One center noted that the staff provided bilingual services.

Another strength listed by the community health centers is the center policy of performing a complete annual physical exam. The new interval physical and history form, according to one center, includes a reminder for the health care provider to ask about CRC screening. At baseline, one center indicated that fecal occult blood testing (FOBT) is suggested when patients are between 40 and 50.* Another center reported that CRC screening is part of their written protocol, which at baseline included digital rectal exam (DRE) and FOBT cards.* Performance indicators in place cover annual FOBT, colonoscopy every 10 years and GI specialist follow-up.

* During the provider CME session, the educator reviewed national guidelines, recommending the initiation of CRC screening at age 50 (including FOBT) for average risk patients. DRE with a single stool guaiac alone was identified as an inappropriate and inadequate CRC screening method to be avoided.

Availability and Accessibility
All centers provide FOBT. One center offers flexible sigmoidoscopies on site. Another center has easy access to DCBE at their back-up hospital, and makes greater use of this screening methodology. All the centers classified as a strength their protocols for initiating the referral process for colonoscopy. The accessibility of the health center to the patient population was also mentioned as a strength at one health center. In the financial arena, center staff commented that the system works well for insured patients, for instance those covered by Medicare. One center listed as a strength their policy not to turn away patients regardless of ability to pay.