Vermont (VT) is a small state with over 61% of residents residing in rural areas. Among VT’s most vulnerable populations are those with lower levels of education and income. The Behavioral Risk Factor Surveillance Survey (BRFSS) indicates 22% of the VT adult population is low income ($25,000 or less). According to BRFSS, 64% of low-income Vermonters have been screened for colorectal cancer (compared to 71% statewide). Our targeted population for this project will be adults age 50-75 that live in three rural counties, Orange, Windsor and Windham, each of which have higher rates of low-income people than the state average. These counties also have rates of colorectal cancer screening that are lower than the state average.
Housed in the Vermont Department of Health (VDH), the Division of Health Promotion and Disease Prevention (HPDP) has demonstrated successes in quality improvement work in health systems. HPDP has worked on numerous initiatives in the past several years in areas including cancer screening, diabetes, tobacco, asthma, cardiovascular disease, and oral health. HPDP will develop subawards with three rural health systems to conduct self-assessments and support the use of evidence-based interventions focusing on high need populations in rural areas. Additionally, HPDP will work with two health system partners, both of whom provide quality improvement technical assistance. As HPDP houses several CDC supported chronic disease programs [Oral Health, National Breast and Cervical Cancer Early Detection Program (NBCCEDP), WISEWOMAN, Tobacco Control, Cancer, and Asthma], cross-program collaboration occurs frequently. A specific collaboration with NBCCEDP is outlined in this proposal. HPDP’s strong history of health system quality improvement through successful partnerships and initiatives positions Vermont to successfully implement the use of evidence-based interventions to increase colorectal cancer screening rates.
VDH has an ongoing commitment to high quality data collection and reporting and program evaluation. Data will be collected from partners to determine baseline rates, progress throughout the program year and annual rates of colorectal cancer screening. The Data Manager who will be assigned to this project is the current data manager for the NBCCEDP and reports data in B & C BARS. Evaluation activities will be overseen by HPDP’s Director of Evaluation. To demonstrate the impact of program activities, evaluation activities will be linked to our ongoing evaluation of evidence-based intervention (EBI) implementation through the NBCCEDP, including with one of the proposed partners for this project. This evaluation has been assessing partner capacity to implement evidence-based interventions, map their implementation process, track related usage and screening rate data, and provide results that inform partners on the impact of EBI implementation and contributes to process improvement at the clinic-level.
The staffing plan outlined in the budget represents a mix of new staff (program manager and evaluator) and a seasoned team of public health and evaluation staff to support them. Our veteran staff have the experience, training, and relationships to support the goals of this grant. The proposed Principle Investigator has over 7 years’ experience managing and overseeing CDC funded programs, including supervision of staff, grant management, and partnership development, with extensive content knowledge in the use of evidence-based interventions to increase screening rates.
Vermont is pleased to extend its expertise in using evidence-based interventions to increase screening through this cooperative agreement. The following narrative and workplan provide details on our partnerships and strategies.