Friday, November 22, 2024
11/22/2024
PROJECT SUMMARY Colorectal cancer (CRC) screening is a cornerstone of cancer prevention and control. Unfortunately, low socioeconomic status (SES) populations such as the uninsured or individuals living in poverty are less likely to receive CRC screening, at least in part because the implementation and dissemination of Evidence-Based Interventions (EBIs) is lower among health-care systems that serve low SES populations. In fact, given the digital divide in health information technology between high- and low-resource health care systems, non-targeted CRC screening programs may negatively impact health equity, whereas programs that specifically target low SES populations may reduce inequities. Although the overall CRC screening rate for the state of Utah is 71.7%, it is heavily patterned on SES. For example, rates of CRC screening in Utah are 75.6% for individuals above the federal poverty level versus 59.2% for those below, and 74.7% for insured individuals versus 27.9% for the uninsured. The most profound racial/ethnic difference in CRC screening in Utah is found between Latino (52.8%) and non-Latino populations (74.1%). Urban/rural/frontier status in Utah also conveys some disparity, although the magnitude is much less – 75% vs. 72% vs. 68% respectively. Thus, low-SES and Latino populations are key targets of the proposed project. Community Health Centers (CHCs) provide comprehensive primary care to low SES populations. In Utah, the 13 CHC systems serve an even more economically disadvantaged population than do CHCs nationally. In 2018, 68% of Utah CHC patients were living below the federal poverty level and 52% were uninsured. CHCs in Utah also serve a disproportionate number of rural and frontier residents, and ~50% of CHC patients are Latino and 9% are Native American. Twelve of the 13 CHC systems in Utah are participating in the proposed project. Of the 28,717 patients eligible for CRC screening at participating CHCs, approximately 20,348 patients have not been screened, yielding a screening rate of 29% vs. 72% for the state of Utah. Thus, Utah CHCs are extraordinary venues for reaching low SES, Latino, and other underserved populations that have extremely low CRC screening rates. The project team includes organizations and individuals with extensive ongoing formal and informal partnerships, and experience and expertise in all aspects of the design, adaptation, implementation, monitoring, and evaluation of EBIs including among Utah CHCs. Key partners include the Huntsman Cancer Institute (HCI) and the University of Utah (UofU), Utah Department of Health (UDOH) Comprehensive Cancer Control Program, UDOH Breast and Cervical Cancer Program, Association for Utah Community Health (AUCH; the federally designated state Primary Care Association), and CHCs across the entire state. The American Cancer Society (ACS), Utah Cancer Action Network, and the Utah Colorectal Roundtable will also be collaborating and coordinating their efforts to support the project. We believe there are several key strengths of the proposed project. First, the project covers the entire state of Utah and 12 of the 13 CHC systems, which serve a very diverse and poor population with exceedingly low CRC screening rates. Second, the project builds on extensive, ongoing partnerships to impact the populations most in need in Utah, and the team’s demonstrated capacity to work together to improve public health. Third, the project leverages the team’s enormous experience, expertise, and national leadership in utilizing health information technology (HIT) and EBIs to change CHC clinical practice. Finally, we utilize a novel, integrated conceptual framework to create sustainable changes that can accelerate the process and sustainability of real world change.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
