Background: Learning health systems are health systems that engage in self-study to improve quality, efficiency, and effectiveness of the care they deliver. HealthPartners, a nonprofit integrated health system in the U.S. Midwest, used systems mapping to understand barriers to member/patient underutilization of colorectal cancer (CRC) screening and identify strategies to address these barriers.
Methods: Semi-structured interviews were conducted with HealthPartners members 50+ years of age (n=40); thematic content analysis revealed barriers to CRC screening. Barriers from a recent national survey of unscreened adults 45–75 years of age (n=1021) also were considered. Stakeholders within and outside of HealthPartners (n=40) familiar with CRC screening constructed causal maps of the identified barriers and strategies to address them. HealthPartners members’/patients’ attitudes toward barrierreduction strategies were assessed in an online survey (age range: 45–75 years; n=261). Lastly, 14 modeling experts and 6 subject matter experts added extensive detail and logic to the barrier/strategy causal maps, transforming them into interconnected systems maps that informed the development of a dynamic simulation model (model results presented elsewhere).
Results: 1) Perceived barriers to CRC screening: invincibility to CRC; unpleasantness/fear of the prep/ test/results; lack of time/resources to get screened; and financial challenges. 2) Surveyed attitudes toward barrier-reducing strategies: a majority of respondents would not be motivated by incentives (64%); many preferred evening (28%) or weekend (41%) colonoscopies; and some would utilize a ride program (37%). 3) Causal maps of barriers/strategies and model structures and their advantages, limitations, and recommendations were delivered for use in simulation model development.
Conclusion: Multimethod, multistakeholder data collection and systems mapping provided participant stakeholders with a deeper understanding of CRC screening underutilization at HealthPartners and identified strategies to improve participation. A beneficial byproduct of the mapping process was new communication/collaboration pathways across the organization. Uncovering patient/member opposition to incentives for CRC screening prevented implementation of a potentially flawed strategy, while discovering patient/member enthusiasm for evening/weekend scheduling and rides led HealthPartners to reconsider these strategies. Systems mapping informed the development of a dynamic simulation model. By enabling virtual experimentation, the model can be used to systematically examine trade-offs between different CRC barrier-reducing strategies, thereby informing strategy adoption at HealthPartners. In sum, systems mapping can be a valuable tool for learning health systems.