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.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-SRLB-R (O1)R)
Program Officer
Parker, Tonya
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Texas Sw Medical Center Dallas
Other Clinical Sciences
Schools of Medicine
United States
Zip Code
Lee, Simon J Craddock; Inrig, Stephen J; Balasubramanian, Bijal A et al. (2018) Identifying quality improvement targets to facilitate colorectal cancer screening completion. Prev Med Rep 9:138-143
Hughes, Amy E; Tiro, Jasmin A; Balasubramanian, Bijal A et al. (2018) Social Disadvantage, Healthcare Utilization, and Colorectal Cancer Screening: Leveraging Longitudinal Patient Address and Health Records Data. Cancer Epidemiol Biomarkers Prev 27:1424-1432
Pruitt, Sandi L; Werner, Claudia L; Borton, Eric K et al. (2018) Cervical Cancer Burden and Opportunities for Prevention in a Safety-Net Healthcare System. Cancer Epidemiol Biomarkers Prev 27:1398-1406
Murphy, Caitlin C; Sigel, Bianca M; Yang, Edward et al. (2018) Adherence to colorectal cancer screening measured as the proportion of time covered. Gastrointest Endosc 88:323-331.e2
Smith, Lauren N; Makam, Anil N; Darden, Douglas et al. (2018) Acute Myocardial Infarction Readmission Risk Prediction Models: A Systematic Review of Model Performance. Circ Cardiovasc Qual Outcomes 11:e003885
Chubak, Jessica; McLerran, Dale; Zheng, Yingye et al. (2018) Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems. Cancer Epidemiol Biomarkers Prev :
Barnes, Arti; Betts, Andrea C; Borton, Eric K et al. (2018) Cervical cancer screening among HIV-infected women in an urban, United States safety-net healthcare system. AIDS 32:1861-1870
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

Showing the most recent 10 out of 40 publications