Colorectal cancer (CRC) remains the second leading cause of cancer related deaths in Texas. Despite the available evidence for the benefits of screening with stool- based or structural examinations, Texas ranks 48th among states for CRC screening completion. Available data suggests that population-based programs can be particularly effective and that critical components for increasing screening rates include high level champions, stakeholder involvement, a convening entity, data driven approaches, defined goals, understanding assets and resources, creating synergies across systems, and collaborations across public health, community organizations and health care organizations. We propose a c...

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Colorectal cancer (CRC) remains the second leading cause of cancer related deaths in Texas. Despite the available evidence for the benefits of screening with stool- based or structural examinations, Texas ranks 48th among states for CRC screening completion. Available data suggests that population-based programs can be particularly effective and that critical components for increasing screening rates include high level champions, stakeholder involvement, a convening entity, data driven approaches, defined goals, understanding assets and resources, creating synergies across systems, and collaborations across public health, community organizations and health care organizations. We propose a center that is informed by the data, addresses all the expectations described in the RFA, and leverages the experiences and expertise of collaborators in relevant disciplines cross the cancer continuum, collegial statewide networks, and shared understanding of current needs across the state. The overall purpose of the Coordinating Center for Colorectal Cancer Screening across Texas (CONNECT) is to galvanize and support CRC prevention efforts in Texas. The Center will be led by Drs. Shokar and Pignone who between them have four decades of experience as primary care physicians, public health scientists and as national and internationally recognized experts and leaders in CRC screening. Between them they have led or co-led 17 successful CPRIT funded cancer prevention programs and have supported adoption and implementation of evidence-based CRC screening strategies across Texas, nationally and internationally. The Center will serve as a convening entity and central hub of resources, tools, and content expertise accessible by stakeholders across the state. The center will consist of: 1) A steering committee that is advisory to the leadership and comprised of physicians in disciplines across the cancer continuum, advocacy groups, CRC screening experts, scientists, leaders of public health and clinic systems and patients representing all geographic regions and populations; 2): Five Cores i. Administrative; ii. Community-based Implementation, Engagement, Education and Health Communication; iii. Clinical Implementation; iv. Modeling, Mapping, Cost effectiveness and Data; v. Advocacy; and 3). A statewide stakeholder network that will include, public, private, governmental, and non-profit organizations, public health organizations, safety net systems, academic health centers, social services organizations, Community Health Worker organizations, payors, governmental entities, advocacy groups, and individuals among others. The work of the center will culminate in creating the infrastructure, capacity and resources to propel Texas' CRC screening efforts forwards. The goals of the Center are to: 1) Create a comprehensive stakeholder network representing all regions and communities in Texas to inform development, implementation & dissemination of a Texas CRC screening strategic plan; 2) Develop infrastructure and resources to support expansion of evidence-based CRC screening statewide; 3) Utilize rigorous evaluation methods and innovative approaches of modeling, geospatial mapping and cost effectiveness analyses to assess impact and support planning, implementation, and policy development; 4) Accelerate the creation, implementation, and dissemination of CRC screening best practices for priority populations. Innovative aspects of the proposal include: 1) use of modeling and mapping expertise; 2) cost effectiveness comparisons across strategies to facilitate flexible and tailored approaches including community-based delivery and mailed FIT approaches; 3) creation of a user friendly web tool to allow policy makers to assess the impact of changing model parameters on screening uptake; 4) health informatics expertise to support integration of EMR tools into clinical workflows for identification, implementation and evaluation; 5) The unique training of the PD and co-PD as scientists, primary care physicians and public health experts who can seamlessly integrate these approaches; 6) expertise in scalable programs involving both community based implementation and health systems-based approaches (mailed FIT programs, payor based, UT Benefits); and 7) health communication expertise to support statewide awareness building across all stakeholder groups.

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