Utah Colorectal Cancer Control Program - Colorectal cancer (CRC) screening is a cornerstone of cancer prevention and control. Unfortunately, low socioeconomic status (SES) populations such as individuals without health insurance, living in poverty, or who live in rural/frontier areas are less likely to receive CRC screening, at least in part because the implementation and dissemination of evidence-based interventions (EBIs) is lower among health-care systems that serve those populations. Although the overall CRC screening rate for the state of Utah in 2022 was 65%, it is heavily patterned on SES. For example, rates of CRC screening in Utah are 67% for individuals above the federal poverty level versus 48% for those below. Substantial differences also exist between urban vs. rural/ frontier areas, e.g. 66% in Salt Lake County vs. 49% in San Juan County respectively.8 Thus, populations with low-SES, without health insurance, and who live in rural areas, are key targets of the proposed project. Community Health Centers (CHCs) provide comprehensive primary care to low SES populations. In Utah, 14 CHC systems serve an even more economically disadvantaged population than do CHCs nationally. In 2024, 58% of Utah CHC patients were living below the federal poverty level, 55% were uninsured, and 47% of CHC clinics are located in rural/frontier areas. Twelve of the 14 CHC systems in Utah are participating in the proposed project. In 2024, of the 35,316 patients eligible for CRC screening at participating CHCs, 23,688 have not been screened, yielding a screening rate of 33% vs. just under 60% for the state of Utah, with substantial variability across CHCs, ranging from 26% to 46%. Thus, Utah CHCs are extraordinary venues for reaching low SES, uninsured, and rural/frontier populations that have extremely low CRC screening rates. The project team includes organizations and individuals with extensive ongoing formal and informal partnerships, and experience and expertise in all aspects of the design, adaptation, implementation, monitoring, and evaluation of EBIs, especially among Utah CHCs. Key partners include the Huntsman Cancer Institute (HCI) and the University of Utah (UofU), Utah Department of Health and Human Services (UDHHS) Comprehensive Cancer Control Program, UDHHS Breast and Cervical Cancer Program, Association for Utah Community Health (AUCH; the federally designated state Primary Care Association), and CHCs across the entire state. We believe there are several key strengths of the proposed project. First, we have made substantial progress in developing partnerships, organization capacity, health information technology infrastructure, and EBI implementation through five years under the current Utah CRCCP. CRC screening rates at UCRCCP participating CHCs increased from 27% in calendar year 2021 to 33% in 2024 after the implementation of EBIs, while CRC screening rates for the state decreased from 74% in 2020 to just under 60% in the same period. Second, the project covers the entire state of Utah and 12 of the 13 CHC systems, which serve a low SES and disproportionately rural/frontier population with exceedingly low CRC screening rates. Third, the project builds on extensive, ongoing partnerships to impact the populations most in need in Utah, and the team’s demonstrated capacity to work together to improve public health. Fourth, the project leverages the team’s enormous experience, expertise, and national leadership in using HIT and EBIs to change CHC clinical practice.
