Changing Health Systems Using Evidence-based Interventions to Increase Colorectal Cancer Screening - The New York State Department of Health (Department) will increase colorectal cancer (CRC) screening rates across New York State (NYS) by partnering with primary care clinics (federally qualified health centers (FQHCs) and rural health centers) with CRC screening rates below 60%, in regions of the State observed to have disparities in CRC screening and/or outcomes (incidence, mortality, disease staging) to increase implementation and enhancement of Community Guide-recommended priority evidence-based interventions (EBIs) (Provider Assessment and Feedback, Provider Reminders, Client Reminders, Reducing Structural Barriers and Patient Navigation). This work will result in short-term outcomes that support patient completion of the CRC screening continuum, including increased stool test kits returned and colonoscopy procedures completed, increased CRC screening in partner clinics, and identification of support for treatment when needed. Colorectal cancer is the second leading cause of cancer death among men and women in NYS. Over 9,000 New Yorkers are diagnosed with CRC annually and approximately 3,000 residents die each year (NYS Cancer Registry). From 2017-2021, nearly 25% of CRC cases in NYS were diagnosed at a distant stage. The percentage of NYS adults aged 45 to 75 years screened for CRC was 69% in 2022, though rates are lower in younger individuals (33% of 45–49-year-olds), those with low household incomes (58% of those making less than $25,000), and those reporting no regular health care provider (39.7%) (NYS Behavioral Risk Factor Surveillance System). NYS Federally Qualified Health Centers and rural health centers serve the Department’s target population for this project including those least likely to be up to date with CRC screening; for example, 57 of NYS’ 63 FQHCs report CRC screening rates below 60%, 48 FQHCs are below 50%. Beginning in Year 1, the Department will partner with four FQHC clinic teams and their clinic champion to conduct a readiness assessment of each clinic’s capacity to implement EBIs and then collaboratively work with each clinic to develop a quality improvement plan to be implemented over twelve months. The Health Center Network of New York (HealthEfficient), which has extensive experience working with health centers to make effective use of their health information technology, will partner with the Department to support clinics in this work. Other supporting partners will collaborate as part of the Project Team to assist with screening needs and sharing results across NYS. The Department will conduct monitoring and evaluation to ensure data quality and will share results across NYS to inform spread of best practices and lessons learned. A formal request for applications will be issued to recruit additional FQHCs and Rural Health Centers in future funding periods. Project activities will support the achievement of the intermediate outcomes of increased numbers of cancers prevented, increased diagnosis of early-stage CRC, and long-term outcome of decreasing CRC incidence and mortality.
