Changing Health Systems Using Evidence-based interventions to increase Colorectal Cancer Screening among Alaska Native People - Background: Alaska Native people have the highest recorded colorectal cancer (CRC) incidence and death rates in the world; twofold higher than among U.S. Whites. While Alaska Native CRC screening rates have been increasing, they remain substantially lower than other populations. CRC screening prevalence is especially low in Alaska’s frontier and remote communities, which are not connected by road to the rest of the state. These communities are served by regional Tribal health systems, who provide the only healthcare available to both Alaska Native and non-Native people living in these areas. Purpose: As a grantee in the CDC CRC Control Program (DP09-903 and DP20-2002), the Alaska Native Tribal Health Consortium (ANTHC), the largest tribally formed and governed non-profit health organization in the nation, has 10+ years’ working with regional Tribal health systems experience using evidence-based interventions (EBIs) to successfully screen Alaska Native and non-Native people in Alaska. Under DP09-903 the ANTHC-led program successfully increased CRC screening in participating Alaska health systems by 68% and by 35% under DP20-2002, despite operating during the COVID-19 pandemic when screening rates dropped across Alaska. Under CDC-RFA-DP25-0012, our specific program population of focus will be the 89,090 people served by seven (7) Alaska regional Tribal FQHC healthcare systems and their 139 community clinics in northwestern, southwestern, and interior Alaska, which is equal in size to Texas, California, and West Virginia combined. We will expand the use of multicomponent EBIs to address barriers and improve CRC screening at participating clinics, whose screening rates vary from 14% to 86%. To increase the efficiency and sustainability of program efforts, we will use health information technology systems changes to better track screening rates, including stool kit return and colonoscopy completion rates. Outcomes: By the end of the 5-year project period, ANTHC will achieve the short-term outcomes of increased implementation and enhancement of EBIs, increased stool tests and colonoscopies completed, increased CRC screening, EBIs implemented, reduced barriers to CRC screening, increased policies and system changes to support access to high quality CRC screening, increased CRC screening EHR data, and increased adherence to CRC screening guidelines. By the end of the project period ANTHC will achieve the intermediate outcomes of increased number of CRCs prevented; increased detection of early-stage CRC; and decreased disparities in Alaska Native CRC screening outcomes. Through this funding ANTHC will also make progress toward long-term outcomes beyond the scope of this project period, including reduced CRC incidence and mortality among Alaska Native people and non-Native people living in frontier Alaska. ANTHC has established itself over the past 20 years as a leader in CRC prevention among Alaska Native people as well as best practices for reaching rural and remote populations. ANTHC has a strong history of innovative program development and effective use of EBIs, CRC screening improvements based on rigorous evaluation results, and deep-seated relationships built with Alaska health systems and supporting state and national partners. ANTHC is committed to continuing that history of excellence with this program to reduce premature death and suffering due to CRC in Alaska. ANTHC has the capacity, the expertise, and the vision to make this program a success.
