According to the District of Columbia Cancer Registry (DCCR), colorectal cancer (CRC) is the fourth most commonly diagnosed cancer and fourth leading cause of cancer death in the District of Columbia (DCCR, 2016). The burden of CRC is unevenly distributed across the District’s populations. Specifically, CRC incidence is nearly 18% higher in men than women; similarly, mortality rates are 36% higher among men. African American (AA) residents are diagnosed with CRC twice as often as any other race [age-standardized incidence rate (AIR) per 100,000 individuals- White-24.3, Other-27.7, AA-49.0]. Additionally, CRC mortality is almost three times higher among AAs compared to Whites [age-standardized mortality rate (AMR) 7.8 vs 20.7 per 100,000 individuals] (DCCR, 2012-2016). In 2018, the District’s overall screening rate was 73.8%, significantly higher than the screening rate among low-income populations (45.9%) (HRSA, 2018). Despite strong evidence that supports effectiveness of CRC screening, men forgo screening more often than women (31.1% vs 22%). By race/ethnicity, 21.8% Non-Hispanic White, 27.3% Non-Hispanic AA, and 34.3% Hispanic did not receive CRC screening.
DC Health’s CDC-funded (DP15-1502) Colorectal Cancer Control Program (DC3C) recognizes that screening represents the best opportunity to reduce CRC burden among District residents. As such, the program has successfully implemented evidence-based interventions (EBIs), client reminders, provider reminders, provider assessment and feedback, reducing structural barriers, and patient navigation (PN) to increase community demand, community access, provider referral and delivery of CRC screening services. In its first four years, the program worked with 20 clinics and achieved significant success by increasing CRC screening rates within partner clinics, from 19% to 35%. Clinics increased the overall number of patients up-to-date with recommended CRC screening from 2,415 (2015) to 5,085 (2018). The infrastructure, capacity, and partnerships that DC3C developed to achieve these outcomes will uniquely position the program to be effective in accomplishing the goals of the new funding opportunity.
DC3C proposes to continue successful EBI implementation to improve CRC screening rates and follow-up among disproportionately affected populations (racial/ethnic minorities, low-income, Wards 5, 6, 7 & 8) to eliminate disparities and decrease the disease burden. The proposed activities use a collaborative approach with a broad range of partners including two FQHCs (Ellaine Ellis Clinic & Unity Health Care), one health system (MedStar Health), the DC Hospital Association (DCHA), the DC Primary Care Association (DCPCA), the regions’ health information exchange provider (Chesapeake Regional Information System for our Patients [CRISP]), a health information technology (HIT) expert (HealthEfficient) specializing in IT management, data reporting and clinical quality improvement (CQI), and multiple community-based stakeholders such as the DC Cancer Coalition, the DC Cancer Registry Advisory Board, and the Patient Navigator Network. This comprehensive network of partners will work collaboratively to build on the successes of the current program by expanding the reach, bolstering technical assistance (TA) and CQI efforts, and addressing gaps in clinical infrastructure, capacity, and workflow to ensure sustainability of EBIs to improve CRC health outcomes, especially among those most vulnerable to the disease.