Need: CRC is the third leading cause of cancer-related deaths in the United States. In Texas, 11,533 Texans are expected to be diagnosed with CRC in 2019, with 4,242 expected to die from the disease over the same period. Rural, uninsured, and minority patients are at particularly high risk for poor CRC screening adherence, are more likely to present with advanced stage CRC, and as such have worse stage-specific survival than other groups. According to a systematic review of the impact of socioeconomic status (SES) on incidence, increased CRC mortality was reported in groups of lower SES and those without a usual source of medical care regardless of geographic region. It is well established t...

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Need: CRC is the third leading cause of cancer-related deaths in the United States. In Texas, 11,533 Texans are expected to be diagnosed with CRC in 2019, with 4,242 expected to die from the disease over the same period. Rural, uninsured, and minority patients are at particularly high risk for poor CRC screening adherence, are more likely to present with advanced stage CRC, and as such have worse stage-specific survival than other groups. According to a systematic review of the impact of socioeconomic status (SES) on incidence, increased CRC mortality was reported in groups of lower SES and those without a usual source of medical care regardless of geographic region. It is well established that CRC screening can save lives through cancer prevention and early detection. Regardless of the screening modality used or the age guidelines followed, there is a national consensus that adherence to screening is of the utmost importance. Similarly, mailed outreach has proven successful as a model for increasing access to CRC screening, resulting in a 2.8-fold relative increase in screening completion when compared to usual care. This is generally attributed with being a multicomponent intervention, addressing community demand through outreach and education and community access through the reduction of structural barriers, in addition to identifying individuals often not-up-to-date with screening or not actively engaged in a health system. These findings relate specifically to the evidence-based methods and goals of the expanded C-SPAN program, which uses mailed FIT outreach to increase access to clinical services and reduce barriers to care for rural and underserved populations. Overall Project Strategy: This project will expand our evidence-based program for CRC screening across a broader geography to help reduce CRC incidence and mortality in Texas, leveraging our prior experience operating both within a closed safety-net system, as well as in an open system approach. Focusing on the nearly 400,000 medically underserved residents across the service area, our program will invite at least 27,347 unique patients to participate in CRC screening and navigation through a targeted mailed outreach in collaboration with our coalition partners. Linkage to care will be navigated by the program team and delivered by clinical partners within the region. The core program components include promoting uptake across the continuum of care to reduce CRC incidence and mortality within the region, coupled with navigation support to ensure access to care. In our targeted approach to mailed outreach, we will work with coalition partners to identify patients who are eligible for screening per the USPSTF guidelines, and establish referral streams for invitation which are episodic (visit-based) or periodic (monthly, quarterly, etc.). We also will continue to encourage participation from those residents not currently engaged in the healthcare system through our robust outreach and education efforts across the service area. This approach provides opportunities for patients to self-enroll in the screening program during community outreach events and health fairs or through our 800 number. In addition to expanding the geographical service area, we will also expand service delivery to include a pilot screening program within the local safety-net system for average-risk patients age 45 – 49, aligning with the revised guidelines from the American Cancer Society. This pilot will provide preliminary data specific to screening interest and adherence rates within this younger population. Specific Goals: As we expand colorectal cancer screening coalition to include an additional 22 counties we intend to develop and implement a framework and metrics for evaluating multilevel interventions (MLI) across a virtual integrated system to optimize delivery of colorectal cancer screening (CRC) services to rural and medically underserved patients. In addition to optimizing performance across a geographic expansion, we will also pilot colorectal cancer screening within a safety-net system for an average-risk population age 45-50, evaluating screening interest along with screening performance, including baseline and annual follow-up, along with diagnostic follow-up. Significance and Impact: Through the expanded C-SPAN coalition we will invite approximately 27,347 eligible patients to engage in CRC screening, processing one or more Fecal Immunochemical Test (FIT) kits for at least 7,765 unique patients, completing at least 491 diagnostic colonoscopies for patients with positive FIT tests, identifying 109 patients with precancerous polyps and diagnosing at least 12 individuals with colorectal cancer. As a result, program implementation will increase CRC awareness, CRC screening and follow-up care in 57 counties across North-Central Texas.

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