Texans suffer disproportionately from colorectal cancer (CRC) and certain regions experience substantial health disparities. A key reason for these disparities is the lack of colorectal cancer screening (CRCS); Texas ranks 49th in CRCS nationwide with only 59.6% of adults aged 50-75 years reporting CRCS in 2019. The overall goal of the proposed program is to increase CRCS through the adoption, implementation, and sustainability of evidence-based interventions (EBIs) in Federally Qualified Health Centers (FQHCs) to ultimately reduce CRC and CRC-related health disparities among African Americans and Hispanics in both rural and urban settings in Texas. To this end, we have convened a group of strategic partners, which we refer to as the Texas Colorectal Cancer Consortium (TC3). This program is led by three institutions: (1) The University of Texas Health Science Center at Houston (UTHealth) which includes: (i) UTHealth School of Public Health (UTSPH) (coordinating applicant) and (ii) UTHealth School of Biomedical Informatics that houses the Gulf Coast regional Extension Center (UTSBMI/ GCREC), (2) The University of Texas Health Science Center Tyler (UTHSC-T), and (3) MD Anderson Cancer Center (MDA). We will work with 9 FQHC systems in two regions of Texas that have CRCS rates that are as low as 4.8% with an average across them of 24%.
TC3 also includes collaborators representing key agencies including the Texas Department of State Health Services (DSHS), the Texas Association of Community Health Centers (TACHC), the American Cancer Society (ACS), and the Cancer Alliance of Texas (CAT). Our partners have a long history of collaboration and possess extensive expertise and experience in developing effective implementation strategies and supporting the use of EBIs for increasing CRCS in primary care clinics. TC3 also includes a Stakeholder and Community Advisory Committee to ensure that program activities and goals are aligned with patient, provider, and stakeholder needs.
Together with our partners, our team will work with these FQHCs, that serve communities with high rates of CRC and low CRCS, to implement four Community Guide recommended EBIs: client reminders, provider reminders, reduction of structural barriers, and provider assessment and feedback. We will also implement patient navigation strategies to address patient-level barriers for screening and follow-up. We will conduct a formal assessment of each clinic's readiness to implement EBIs and work with them to address contextual factors influencing readiness. We will develop tailored implementation strategies using Implementation Mapping, a participatory and systematic approach for developing or selecting implementation strategies that are most useful and effective for each FQHC. Our implementation team will support clinics using tailored implementation strategies (practice facilitation, EHR optimization, ECHO telementoring, program champions) to enhance adoption, implementation, and maintenance of the EBIs. We will also assist partner clinics to implement strategies that support completion of follow-up colonoscopies after a positive or abnormal CRCS. We will provide resources for uninsured or underinsured individuals with no access to other programs. The evaluation Team and FQHC will ensure that high-quality clinic-level data is collected, including baseline and annual CRCS rates to assess the impact of these activities. Data will also be used as part of an ongoing quality-improvement process.
The proposed project builds on long-standing relationships with our FQHC and implementation partners and benefits from available resources to cover CRCS and follow-up for patients with no ability to pay. The proposed program will enable a sustained increase in CRCS rates among FQHCs reaching severely underserved and minority populations in Texas to reduce the burden of CRC and CRC-related health disparities.
