Need: Colorectal cancer (CRC) screening in adults ages 50-75 can reduce CRC incidence and mortality, but implementation and uptake of screening has been sub-optimal, particularly for vulnerable patients, including those who receive care in Federally Qualified Health Centers (FQHCs).

We and others have shown that mailing of fecal immunochemical tests (mailed FIT) can increase screening rates over reliance only on traditional, practice-based approaches, and is especially effective when coupled with patient navigation to help vulnerable patients overcome barriers to completion of follow-up colonoscopies. Over the past 2 years, we have successfully reached out to over 25,000 vulnerable patients...

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Need: Colorectal cancer (CRC) screening in adults ages 50-75 can reduce CRC incidence and mortality, but implementation and uptake of screening has been sub-optimal, particularly for vulnerable patients, including those who receive care in Federally Qualified Health Centers (FQHCs).

We and others have shown that mailing of fecal immunochemical tests (mailed FIT) can increase screening rates over reliance only on traditional, practice-based approaches, and is especially effective when coupled with patient navigation to help vulnerable patients overcome barriers to completion of follow-up colonoscopies. Over the past 2 years, we have successfully reached out to over 25,000 vulnerable patients within one FQHC system in Travis County, leading to over 5,000 previously unscreened patients being screened, and more than doubling the proportion of patients up to date with screening from 19% at baseline to over 40%. We are currently expanding this work to a second FQHC system in Year 3. However, many uninsured and underinsured patients remain unscreened, providing a strong rationale for an expanded program.

Overall Project Strategy: We propose to expand, in partnership with CUC and LSCC, two local FQHC networks, our successful, multi-faceted intervention that includes provider education, mailed FIT, access to patient navigation for improving timely follow-up of positive FIT, development of a screening and surveillance registry, and enhanced access to colonoscopy for vulnerable urban and rural patients in Central Texas. A key aspect of the expanded program will be extension of its work to rural areas of Central Texas that have not been served by existing mailed FIT programs.

Specific goals: We plan to reach out to approximately 20,000 patients per year who are due for CRC screening, with the goal of increasing the screening rate by at least 10% points and maintaining it over 3 years. We will also ensure that more than 70% of patients with positive FIT complete colonoscopy within 120 days and that at least 50% of those at high-risk or due for surveillance colonoscopy complete examinations each year.

Significance and Impact: Increasing CRC screening in vulnerable patients in Central Texas will reduce CRC incidence and mortality, and decrease overall costs of care through reduction in treatment costs. Lessons learned from our expanded mailed FIT program will be used to develop plans for a state-wide program to meet the needs of vulnerable patients throughout Texas.

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