Optimizing Health Systems for Colorectal Cancer Screening: Implementation of Evidence-Based Interventions to Increase Colorectal Cancer Screening in Texas Federally Qualified Health Centers - Background: Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality in the United States. CRC incidence in Texas (37.9 per 100,000) is higher than the national average (34.9 per 100,000), with certain counties experiencing much higher rates. Texas ranks 49th in colorectal cancer screening (CRCS) prevalence. Disparities in screening access and uptake persist, particularly among underserved populations in East Texas and the Greater Houston area, where CRC incidence and mortality rates are disproportionately high and screening is low. Patients served by Federally Qualified Health Centers (FQHCs) face significant barriers to screening, with rates as low as 7.34% in some Texas FQHC clinics. Objective and Partnerships: The Texas Colorectal Cancer Consortium (TC3), led by UTHealth Houston, aims to improve CRCS rates and reduce CRC disparities among populations served by FQHCs in both rural and urban settings by enhancing adoption, implementation, and sustainment of evidence-based interventions (EBIs). The TC3 builds on the ongoing CDC-funded Texas Colorectal Cancer Control Program (CRCCP) and leverages strong partnerships with FQHCs, state agencies, academic partners (UT MD Anderson Cancer Center, UT Health Science Center Tyler), the Texas Association of Community Health Centers (TACHC), the American Cancer Society (ACS), and the Cancer Alliance of Texas (CAT), among others. Our partners have a long history of collaboration and extensive expertise in developing effective implementation strategies and supporting the use of EBIs to increase CRCS in primary care clinics. TC3 also includes a Stakeholder and Community Advisory Committee to ensure that program activities and goals align with patient, provider, and community-based organization needs. Methods: TC3 will partner with six FQHC systems (26 clinics) in East Texas and Greater Houston regions to implement a multi-strategy approach aligned with the CDC CRCCP model. First, we will establish and enhance partnerships between FQHCs, supporting organizations, and community-based stakeholders to facilitate EBI adoption and implementation. Second, we will support FQHCs in implementing at least three CRCS EBIs, including patient and provider reminders, provider assessment and feedback, patient navigation, and strategies to reduce structural barriers such as transportation and cost. Third, rigorous monitoring and evaluation will ensure high-quality data is used to inform program activities. Clinic-level CRCS prevalence will be tracked quarterly through EHR extractions and manual chart reviews, and reported to the CDC annually. A CRCS Program Data Dashboard will be developed to facilitate real-time data sharing and continuous quality improvement. Fourth, we will ensure the completion of screening and follow-up for abnormal results by strengthening clinic workflows, referral coordination, and addressing social determinants of health through partnerships. Expected Outcomes: Over the project period, the program aims to increase CRCS rates by at least 50%, improve provider adherence to screening guidelines, enhance EHR functionality to track the screening process, and ensure timely diagnostic colonoscopy referrals for patients with abnormal test results. We will also strengthen partnerships to provide patient navigation, transportation, and financial assistance for CRC screening and treatment services. Impact: The TC3 initiative will reduce CRC disparities in Texas, particularly in high-risk and underserved communities and will create a sustainable model for integrating EBIs into FQHCs, enhancing healthcare delivery, and improving health outcomes. Findings from this initiative will contribute to national best practices for CRC prevention and control, informing future policy and programmatic efforts to increase screening and reduce cancer disparities at scale.
