Parkland-UT Southwestern PROSPR Center: Colon cancer screening in a safety net The Parkland-UT Southwestern PROSPR Center represents a fully coordinated, trans-disciplinary partnership of the Parkland Health System, UT Southwestern Medical Center, Simmons Cancer Center, and UT School of Public Health. Our goal is to optimize colon cancer screening through personalized regimens in our integrated safety-net clinical provider network serving a large and diverse population of under- and uninsured patients in Dallas. Three interlocking research projects will assess clinic, system, and organizational factors associated with over-, under- and guideline-based screening among this vulnerable population, and will compare benefits, harms, and costs of strategies for facilitating optimized screening regimens. Project 1 employs an """"""""in-reach"""""""" strategy by implementing innovative, algorithmically driven tools in primary-care and colonoscopy clinics to collect information including patients'familial risk factors and colonoscopy findings to: identify personalized guideline-based screening regimens;characterize under- and over-screening. Project 2, a comparative effectiveness trial, compares benefits, harms and costs resulting from two system level, mailed outreach strategies for promoting effective screening: the first strategy begins with a mailed fecal immune-histochemical test kit;the second begins with a mailed invitation for colonoscopy;both include centralized processes to assure guideline-based follow up. Project 3 characterizes organizational factors at the network and clinic level that contribute to completion of screening processes and examines which organizational factors modify relationships between social disadvantage and completion of guideline-based screening processes. Parkland, the sole safety-net provider in Dallas County, is a vertically integrated delivery system that includes 11 primary care clinics caring for 32,000 adults (50-64 yrs) and has a comprehensive electronic record through which eligibility for a test, test ordering, results, referrals, and treatment are ascertainable. Through these capabilities, the Screening Process Documentation Unit will: collect accurate, clinically detailed data on all relevant processes and outcomes across the screening process, and link to the ACCR Gold-Star Texas Cancer Registry;facilitate data transfers to the national data coordinating center;and work closely with the Shared Research Resources Core to provide all data needed for Projects 1-3.

Public Health Relevance

Colorectal cancer is the 2nd cancer killer despite the fact that effective screening saves lives. Low-income and minority patients in safety-net health systems are least likely to receive effective screening. To address these disparities, our PROSPR Center will develop new tools to improve screening in clinics, compare benefits and harms of two common outreach strategies for promoting screening, and identify clinic policies and procedures that lead to best practices for effective screening.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
1U54CA163308-01
Application #
8223416
Study Section
Special Emphasis Panel (ZCA1-SRLB-R (O1))
Program Officer
Ambs, Anita
Project Start
2011-09-23
Project End
2016-08-31
Budget Start
2011-09-23
Budget End
2012-08-31
Support Year
1
Fiscal Year
2011
Total Cost
$1,248,741
Indirect Cost
Name
University of Texas Sw Medical Center Dallas
Department
Other Clinical Sciences
Type
Schools of Medicine
DUNS #
800771545
City
Dallas
State
TX
Country
United States
Zip Code
75390
Martin, Jason; Halm, Ethan A; Tiro, Jasmin A et al. (2017) Reasons for Lack of Diagnostic Colonoscopy After Positive Result on Fecal Immunochemical Test in a Safety-Net Health System. Am J Med 130:93.e1-93.e7
Balasubramanian, Bijal A; Garcia, Michael P; Corley, Douglas A et al. (2017) Racial/ethnic differences in obesity and comorbidities between safety-net- and non safety-net integrated health systems. Medicine (Baltimore) 96:e6326
Skinner, Celette Sugg; Ahn, Chul; Halm, Ethan A et al. (2017) Recommendation of colorectal cancer testing among primary care patients younger than 50 with elevated risk. Prev Med 102:20-23
Hughes, Amy E; Pruitt, Sandi L (2017) The utility of EMR address histories for assessing neighborhood exposures. Ann Epidemiol 27:20-26
Singal, Amit G; Gupta, Samir; Skinner, Celette Sugg et al. (2017) Effect of Colonoscopy Outreach vs Fecal Immunochemical Test Outreach on Colorectal Cancer Screening Completion: A Randomized Clinical Trial. JAMA 318:806-815
Chubak, Jessica; Garcia, Michael P; Burnett-Hartman, Andrea N et al. (2016) Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems. Cancer Epidemiol Biomarkers Prev 25:344-50
McCarthy, Anne Marie; Kim, Jane J; Beaber, Elisabeth F et al. (2016) Follow-Up of Abnormal Breast and Colorectal Cancer Screening by Race/Ethnicity. Am J Prev Med 51:507-12
Klabunde, Carrie N; Zheng, Yingye; Quinn, Virginia P et al. (2016) Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly. Am J Prev Med 51:e67-75
Singal, Amit G; Gupta, Samir; Tiro, Jasmin A et al. (2016) Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: A randomized controlled trial in a safety-net health system. Cancer 122:456-63
Armstrong, Katrina; Kim, Jane J; Halm, Ethan A et al. (2016) Using lessons from breast, cervical, and colorectal cancer screening to inform the development of lung cancer screening programs. Cancer 122:1338-42

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