Changing Health Systems Using Evidence-based interventions to increase Colorectal Cancer Screening - Burden: Colorectal cancer (CRC) related morbidity and mortality along with low screening rates represents a major problem in Massachusetts (MA), which is disproportionately felt by members of specific racial/ethnic groups and geographic areas. For example, in 2016-2020, Black residents had higher mortality rates when compared to other racial groups (e.g., White Non-Hispanic, Hispanic). From 2016-2020, Dukes and Berkshire counties had higher than average age-adjusted CRC incidence rates than other counties. Mortality rates were also higher in specific counties such as Hampden County. Among members of some of these same groups, CRC screening rates are also especially low. For example, in 2022, Black, non-Hispanic (65.8%) and Hispanic/Latine (54.9%) residents had significantly lower percentages of up-to-date CRC screening compared to White, non-Hispanic respondents (75.7%). In 2020, the age-adjusted CRC screening prevalence in Hampden County was one of the lowest among all MA counties. Purpose: It is in this context that the Massachusetts Department of Public Health (MDPH) aims to increase screening and reduce the CRC burden for Massachusetts residents and especially those from these particularly burdened groups (e.g., Black and Hispanic individuals and those from Dukes, Berkshire, Hampden counties). With this goal in mind, MDPH proposes to partner with community health centers and federally qualified health centers (FQHCs) that disproportionately serve these populations and typically have lower CRC screening rates. For example, in 2022, FQHCs in MA reported a lower screening prevalence than the state average for patients ages 45-75 years in 2022 (50.9% versus 71.5%). Approach: MDPH will partner with the Massachusetts League of Community Health Center (Mass League) to increase CRC screening in FQHCs and community health centers by supporting implementation of evidence-based interventions (EBIs). Specifically, MDPH will lead a Colorectal Cancer Screening Learning Collaborative. The CRC Screening Learning Collaborative will provide technical assistance and coaching to FQHCs and CHCs to implement multicomponent EBIs, establish a high-quality fecal immunochemical test (FIT) program, and optimize electronic health records (EHRs) for better data tracking and EBI implementation. The Learning Collaborative will also focus on sustainability planning to ensure long-term impact of these strategies. MDPH requests $710,054 to support its colorectal cancer screening efforts. If awarded funding, MDPH will leverage its current infrastructure and strong internal partnerships to provide targeted outreach to the aforementioned populations and to provide population-based cancer education and awareness on importance of colorectal cancer screening. MDPH will also engage with external partners to enhance access to follow-up colonoscopies and support services and to cross-share resources, best practices, training opportunities and strategies to bolster EBI implementation at partner health systems. Outcomes: Over the course of this grant, we aim to recruit at least 10 to 12 partner clinics and engage at least five supporting partners to implement these strategies effectively. Our anticipated outcomes include an increase in the adoption of EBIs, increased stool test kits returned and colonoscopy procedures completed, and increased CRC screening.
