Increase colorectal cancer screening through partnerships using evidence-based interventions. - Despite being largely preventable through screening, colorectal cancer (CRC) remains the second most common cause of death from cancer in the U.S. CRC screening tests can prevent CRC by removing pre-cancerous growths called polyps before they can develop into CRC, and screening tests also allow CRC to be found at earlier stages (early detection). Increasing screening significantly decreases the incidence and deaths from CRC, but much work remains to be done to accomplish that essential public health goal. The 2022 Behavioral Risk Factor Surveillance System (BRFSS) showed that over 32% of eligible Americans age 45-75 have never been screened, and in NH individuals age 45-54 have a 50% screening rate. Underserved populations experience multiple barriers to CRC screening, which results in much lower screening rates and higher incidence of CRC in those populations. Individuals less than age 50 have been found to have a concerning increase in CRC over the past few decades; this is also the case in New Hampshire (NH). Our program works to increase CRC screening for underserved people age 45-75; people at risk for early onset colorectal cancer are part of that focus. The work of our proposed project is to develop partnerships to increase screening rates, targeting those efforts to clinics that serve people experiencing the greatest lack of screening resources and therefore least likely to be receiving this life-saving health care. Using evidence-based interventions (EBIs), which are interventions that have been shown to be effective (such as patient reminders), we work to increase high-quality CRC screening in our partner clinics. NH is one of the most rural states in the U.S., and our partner clinics are located in counties that are among the most rural in the state. In addition to geographic barriers, higher rates of being uninsured and lower annual household income are among the many obstacles faced by this population. NH has a rapidly expanding aging population, as well as much recent population growth, leading to many additional people for whom screening rates are well below state and national averages. Many of these individuals are served within FQHC health centers. Therefore, an important part of our proposed work is collaboration with the New Hampshire (NH) Community Health Access Network (CHAN), which supports many electronic health record (EHR) functions for FQHCs. Working with our clinic partners and CHAN, we will be able to make major improvements in clinic EHRs, which will support providers in increasing CRC screening in NH FQHCs. In NH the CDC Colorectal Cancer Control Program (CRCCP), known as the NH Colorectal Cancer Screening Program (NHCRCSP), has built a large and active network of partners, champions, and collaborators, and currently is working with 9 clinics, 341 active providers, and many other partners. By developing additional partnerships and meaningful collaborations through this funding opportunity, NHCRCSP will continue to successfully implement EBIs with new partners and thereby increase CRC screening rates, resulting in many additional people screened at our partner clinics. NHCRCSP has a strong foundation that will allow us to work successfully with new and existing partners, reaching the underserved and unscreened in the most rural areas of the state. To reach the long-term goal of decreasing the incidence and mortality of CRC, we must increase prevention and early detection through screening, and that is the overall goal of our work.
