The Minnesota Department of Health’s colorectal cancer (CRC) control program (Sage Scopes) will work in partnership with the American Cancer Society (ACS), the Minnesota Cancer Alliance (MCA), the American Indian Cancer Foundation (AICAF), primary care clinics, health care systems, and other partners to increase CRC screening in the entire state of Minnesota via systems change approaches.¿In Minnesota, cancer is the¿leading cause of mortality and CRC is the third most common cause of cancer deaths. On average, 2,350 Minnesotans are diagnosed with CRC each year. In caring for these individuals, Minnesota¿insurers will¿spend $125 million a year on CRC treatment. Screening can have a great impact on CRC incidence and mortality; half of all CRC cases are preventable and screening alone can prevent more than 60% of CRC deaths. While Minnesota’s CRC screening rate (74%) is above the national rate (69%), this rate masks significant disparities in CRC cancer screening, incidence, and mortality among some populations, such as POC, and American Indians, uninsured, and Medicaid recipients. Rural populations in Minnesota also have lower CRC screening rates and large absolute numbers of unscreened individuals.
The proposed project builds on the extensive work of Minnesota’s CDC-funded projects (e.g. NBCCEDP, CRCCP, CCCP, WW). Our work is guided by two aims: 1) Target disparities in CRC screening, incidence, and mortality emphasizing the uninsured, Medicaid, POC and American Indians, and rural populations; and 2) Integrate sustainability into health systems/clinic change efforts to potentiate long term CRC screening, incidence, and mortality outcomes. To address barriers to CRC screening, increase CRC screening rates, and improve the quality of CRC screening and follow-up testing in MN, we are seeking funding to implement and evaluate the following strategies:
• Establish partnerships with primary care clinics and health systems with CRC screening rates below 60% that serve high-need populations experiencing CRC disparities in incidence, mortality, and screening rates.
• Support partners and clinics to implement EBIs, identify resources, and create a desire and need for CRC screening in communities throughout MN.
• Work with partners to complete implementation readiness assessments and EBI implementation at primary care clinic partners. Assessments will include baseline data, EHRs, data systems, clinic flow and strengths and barriers to implementation.
• Provide clinics consultative support to facilitate the identification and implementation of two or more EBIs that reach high priority populations (e.g. provider assessment and feedback, provider reminder systems, patient reminders, or structural barriers reduction).
• Facilitate linkage to CRC screening, follow-colonoscopy, and treatment as needed by working with clinics to implement culturally and linguistically appropriate patient navigation services that effectively reach diverse and underserved target populations.
• Measure outcomes reflecting our guiding aims to increase the number of CRC cancers prevented; increase diagnosis of early stage CRC; & reduce disparities in state-level CRC screening rates, prevention and early stage CRC diagnosis.
To achieve these outcomes, Scopes will work with 26 clinics over the 5 year program, extending our reach to 40,000 individuals, of which about 70% are members of target populations.