SOUTH CARE HEALTHCARE IMPROVEMENT TRANSFORMATION (SC-HIT) - Colorectal cancer (CRC) is the second leading cause of cancer death in the United States (US) for men and women combined and resulted in 53,010 estimated deaths in 2024.1–4 CRC mortality is higher in US counties with persistent poverty (20.1 per 100,000) than counties with non-persistent poverty (17.1 per 100,000) from 2007-20115. South Carolina (SC) CRC mortality (13.4) is above the National average (13.1), though the overall State incidence (35.5) is lower than the National average (35.9). In the project we will work with 21 clinics in 11 counties, two of which are amongst the top 400 counties in the Nation for the worse CRC incidence (Darlington, Marion), and mortality (Marion) . Since CRC screening significantly reduces incidence and mortality of this cancer, the Colorectal Cancer Prevent Network (CCPN) proposes to assist clinics with Continuous Quality Improvement (CQI) activities that will focus on integrating 3 to 5 EBIs, known to increase CRC screening participation, in their clinical workflow. CCPN will support the clinics’ use of rigorous and validated CRC screening data obtained from EMR and Azara reports to measure the impact of the EBI implementation or enhancement on stool-test return, colonoscopy completion, and overall screening rates, which align with three short term outcomes of this cooperative agreement (1-Increase implementation and enhancement of EBIs in partner clinics. 2-Increase stool test kits returned and colonoscopy procedures completed among patients in partner clinics. 3-Increase CRC screening in partnering clinics). Clinics will be required to engage in monthly/quarterly activities designed to support and sustain the implementation of 3 to 5 EBIs. CCPN will assist clinics by offering technical assistance (TA) and partner with 3 external organizations whose expertise in CQI (HealthTeamWorks), data capture and reporting from EMR and Azara (South Carolina Primary Health Care Association) and sustainability (Washington University at St. Louis) will support sustainable EBI implementation/enhancement and rigorous validated data on CRC screening, stool-based test and colonoscopy completion. To further enhance clinics' knowledge of best practice in CRC screening, clinics will be encouraged to participate in the South Carolina Department of Public Health (SCDPH) Cancer ECHO. The project is designed around CDC’s 4 Strategies that will be achieved through 5 phases of activities: Phase 1 clinic enrollment and capacity building, Phase 2 EBI implementation, Phase 3 outcomes and sustainability, Phase 4 Interest holder engagement and Phase 5, continuous sustainability. Each phase of activities has been developed to address each strategy over a period of 5 years. In Strategy 1: We will establish and enhance our existing partnerships between primary care clinics, supporting partners, and their surrounding community during Phase 1, Phases 3 through 5. For Strategy 2: CPPN will support primary care clinics’ implementation of EBIs to increase CRC screening rates in Phases 1 through 5. In Strategy 3: CCPN will implement a robust evaluation plan that will include monitoring and evaluation of clinics’ CRC data to ensure rigorous CRC quality data in Phases 1 through 5. Finally, for Strategy 4: The CCPN will support primary care clinic efforts to increase patients’ completion of stool-based tests, other CRC screening modalities, and follow-up due to abnormal screening results in Phases 2 to 5 of the project. These activities aim to achieve the short-term outcomes mentioned above.
