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Implementation Research to Cut Colorectal Cancer Disparities

Institution: University of California, Los Angeles
Investigator(s): Roshan Bastani, Ph.D.
Award Cycle: 2019 (Cycle 28) Grant #: 28IR-0059 Award: $910,175
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: High Impact Research Project Award

Initial Award Abstract

Colorectal cancer (CRC) is the second most common cause of cancer mortality in the U.S and screening is underutilized (62% U.S. rate in 2015). In California, 71% of eligible adults were screened for CRC in 2016, with lower rates among Latinos (54%). This disparity is urgent given Latinos are the fastest growing population in the U.S. and the largest ethnic group in California (38%) and LA (48%).

To address this issue, UCLA is partnering with Northeast Valley Health Corporation (NEVHC), a multi-site Federally Qualified Health Center (FQHC) that serves an uninsured/publicly insured, low income, Latino (86%) population in LA. Only 38% of the 12,270 eligible NEVHC patients have received CRC screening.

The primary aim of this project is to increase CRC screening at NEVHC. We will implement and evaluate a program that includes patient, provider and health-system elements. We will use a research design that allows us to examine CRC screening using information from NEVHC’s electronic health record (EHR).

Physicians and staff will receive training, clinical decision support and feedback on screening rates and missed opportunities. System-level changes will focus on workflow changes to ensure providers are informed of patients due for screening and that eligible patients receive a fecal immunochemical test (FIT). During clinical visits, patients will receive a strong provider recommendation, a FIT and culturally-tailored instructions, consultation with a bilingual clinic staff member and a text message reminder the day after their visit. Patients who do not return a FIT in 10 days will receive a second text and a mailed reminder.

We expect our program will result in higher CRC screening rates, fewer missed opportunities to provide FITs at clinic visits, and increased FIT return. In addition to testing intervention effectiveness, we will closely examine implementation of our program to understand factors that may facilitate or hinder uptake and success.

Our project balances scientific rigor with a “real world” implementation approach. FQHCs provide essential care to underserved groups and have the infrastructure to sustain effective cancer care delivery strategies. Findings from this work will be critical for informing sustainability and dissemination efforts.