The federal government has set a Healthy People 2020 goal of a 70.5% screening rate for colorectal cancer (CRC), but almost half of eligible U.S. adults are not up to date on their screenings. Among minority and low-income populations, the CRC screening rate is extremely low. To address this disparity, we will develop and test a culturally tailored, health care system-based program to improve CRC screening rates in OCHIN, a community-based collaborative network of more than 200 Federally Qualified Health Centers (FQHCs). Racial and ethnic minorities, along with low-income and medically underserved populations, increasingly receive their primary care at FQHCs, which serve nearly 19 million patients annually throughout the United States. OCHIN is the largest national FQHC network. Its integrated electronic health record system combining medical, laboratory, and claims data will serve as a novel and robust data source for our study. In Phase I (Year 01), we will pilot-test an evidence-based approach to improving participation in CRC screening in two OCHIN FQHCs. This phase will include an assessment of the intervention's feasibility, effectiveness, and cost. In Phase II (Years 02-05), we will conduct a comparative effectiveness pragmatic clinical trial, using a mixed-methods approach to evaluate the adoption, implementation, and maintenance of our CRC screening program designed explicitly for FQHC clinics. Throughout the project, we will work with a diverse planning advisory group of OCHIN clinicians and patients, community representatives, state policy makers, and researchers, using principles of Community-Based Participatory Research. Because OCHIN is the largest single FQHC network and serves patients who are diverse in race, ethnicity, and insurance status, our results will play a transformative role in accelerating CRC screening research in underserved populations. Our program will expand meaningful use of electronic health information;synergistically meet national goals to improve cancer screening rates, address health disparities, and reduce health care costs;and act as a catalyst for future systems-based approaches to improve care delivery in FQHCs and other health systems.

Public Health Relevance

Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Rates of CRC screening are extremely low in patients at Federally Qualified Health Centers (FQHCs), which serve nearly 19 million patients annually. We will test an intervention to improve rates of CRC screening in a group of FQHCs. We intend for our program to be a model for other FQHCs and health systems.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Exploratory/Developmental Cooperative Agreement Phase I (UH2)
Project #
1UH2AT007782-01
Application #
8465357
Study Section
Special Emphasis Panel (ZAT1-DB (33))
Program Officer
Khalsa, Partap Singh
Project Start
2012-09-30
Project End
2013-12-31
Budget Start
2012-09-30
Budget End
2013-12-31
Support Year
1
Fiscal Year
2012
Total Cost
$769,171
Indirect Cost
$183,633
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
150829349
City
Oakland
State
CA
Country
United States
Zip Code
94612
Coronado, Gloria D; Schneider, Jennifer L; Petrik, Amanda et al. (2017) Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders. Transl Behav Med 7:557-566
Simon, Gregory E; Coronado, Gloria; DeBar, Lynn L et al. (2017) Data Sharing and Embedded Research. Ann Intern Med 167:668-670
Weinfurt, Kevin P; Hernandez, Adrian F; Coronado, Gloria D et al. (2017) Pragmatic clinical trials embedded in healthcare systems: generalizable lessons from the NIH Collaboratory. BMC Med Res Methodol 17:144
Coronado, Gloria D; Retecki, Sally; Schneider, Jennifer et al. (2016) Recruiting community health centers into pragmatic research: Findings from STOP CRC. Clin Trials 13:214-22
Oluloro, Ann; Petrik, Amanda F; Turner, Ann et al. (2016) Timeliness of Colonoscopy After Abnormal Fecal Test Results in a Safety Net Practice. J Community Health 41:864-70
Larson, Eric B; Tachibana, Chris; Thompson, Ella et al. (2016) Trials without tribulations: Minimizing the burden of pragmatic research on healthcare systems. Healthc (Amst) 4:138-41
Cook, Andrea J; Delong, Elizabeth; Murray, David M et al. (2016) Statistical lessons learned for designing cluster randomized pragmatic clinical trials from the NIH Health Care Systems Collaboratory Biostatistics and Design Core. Clin Trials 13:504-12
Coronado, Gloria D; Petrik, Amanda F; Spofford, Mark et al. (2015) Clinical perspectives on colorectal cancer screening at Latino-serving federally qualified health centers. Health Educ Behav 42:26-31
Coronado, Gloria D; Schneider, Jennifer L; Sanchez, Jennifer J et al. (2015) Reasons for non-response to a direct-mailed FIT kit program: lessons learned from a pragmatic colorectal-cancer screening study in a federally sponsored health center. Transl Behav Med 5:60-7
Coronado, Gloria D; Petrik, Amanda F; Bartelmann, Sarah E et al. (2015) Health Policy to Promote Colorectal Cancer Screening: Improving Access and Aligning Federal and State Incentives. Clin Res (Alex) 29:50-55

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