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

OBJECTIVE: To examine changes in colorectal cancer (CRC) screening rates over time and determine organizational-level factors influencing these shifts. STUDY SETTIGN AND DESIGN: 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. DATA SOURCES AND ANALYTIC SAMPLE: 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. PRINCIPAL FINDINGS: 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. CONCLUSIONS: 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.