J Rural Health. 2026 Jun;42(3):e70203. doi: 10.1111/jrh.70203.
ABSTRACT
PURPOSE: Mailed fecal immunochemical test (FIT) and patient navigation for follow-up colonoscopy have been shown to increase colorectal cancer (CRC) screening rates, but implementation barriers exist in rural settings. Partnerships between clinics and Medicaid health plans may address these barriers. In a large pragmatic randomized trial, we conducted a qualitative analysis to identify ways in which practice facilitation supported the implementation of a partnered health plan-clinic intervention of mailed FIT and patient navigation to improve CRC screening among rural Medicaid enrollees.
METHODS: In the SMARTER CRC pragmatic trial, study team practice facilitators supported rural clinics and Medicaid health plans in implementing mailed FIT and patient navigation for follow-up colonoscopy. Qualitative data collected during the first year of implementation included clinic and health plan interviews, clinic contact logs, and monthly periodic reflections with the facilitator team.
FINDINGS: Practice facilitation was needed to support both clinics and health plans in the study. Facilitators supported continued engagement of clinics and health plans, used workflow mapping to align implementation between clinics and health plans, provided technical support for sharing of patient data, and facilitated communication between clinics and health plans. Prior study team experience implementing CRC screening interventions enabled successful facilitation.
CONCLUSIONS: Practice facilitation can successfully support partnered health plan-clinic implementation of mailed FIT and patient navigation in rural clinics. Our findings highlight the importance of assessing support needs across all partnering organizations when implementing multilevel preventive care interventions and underscore the importance of subject matter expertise in practice facilitation.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04890054.
PMID:42572815 | DOI:10.1111/jrh.70203
