Changing Health Systems Using Evidence-based Interventions to Increase Colorectal Cancer Screening - PROJECT ABSTRACT SUMMARY Background/Need: Quality Health Associates of North Dakota (QHA) is submitting this application to participate in the Public Health and Health Systems Partnership to Increase Colorectal Cancer Screening in Clinical Settings. ND ranks 26th in colorectal cancer (CRC) screening rates, with a rate of 72.4% (2022 BRFSS). However, this data conceals significant disparities in CRC screening rates among tribal populations and individuals served by Federally Qualified Health Centers (FQHCs). In 2022, BRFSS data revealed that colorectal cancer (CRC) screening rates among Native Americans in ND were 27% lower than those of the non-Native American population. Additionally, the 2023 FQHC Uniform Data System reported CRC screening rates for the four Health Centers in ND ranging from 27.72% to 61.70%. Objectives/Purpose: The purpose of this program is to help North Dakota’s primary care clinics increase CRC screening prevalence among underserved populations in North Dakota, particularly focusing on American Indian communities and patients served by FQHCs. The goal is to enhance screening prevalence, prevent colorectal cancers, reduce late-stage diagnoses, and decrease CRC mortality. Approach: In the first year, QHA will partner with the ND FQHC with the lowest CRC screening rates and two tribal clinics to implement evidence-based interventions (EBIs). These interventions will include provider and patient reminders, reducing structural barriers, and patient navigation. In subsequent years, QHA will expand its efforts to 3-5 additional FQHCs and tribal clinics each year. The strategy involves conducting comprehensive readiness assessments and developing clinic-specific action plans. QHA staff will provide technical assistance rooted in quality improvement methodology, share resources, tools, and materials, and conduct frequent site visits and coaching calls to monitor progress, identify barriers, and develop mitigation strategies. Additionally, QHA staff will assist clinic staff in leveraging their electronic health records (EHRs) to collect and report CRC screening program measures. This support will include a robust data quality validation and feedback process. Staffing and Capacity: QHA has a proven track record of successfully implementing quality improvement initiatives. Our CRC team will include experienced project managers, quality improvement specialists, and EHR specialists adept at leveraging EHRs to collect quality and population health data. Additionally, our CRC Screening Program Evaluation Team, consisting of both internal and external partners and stakeholders with extensive program evaluation experience, will support the program's effectiveness. Expected Outcomes: The project aims to achieve a significant increase in CRC screening rates, with each participating clinic implementing at least three EBIs. Improved screening rates will lead to earlier detection and treatment of colorectal cancer, ultimately reducing CRC incidence and mortality in the targeted populations.
