Need: The five-year survival rate in Texas for those diagnosed with localized colorectal cancer (CRC) is 91%, but only about 35% of CRC is found in this early stage among ages 50 to 64 and only 26% of CRC is localized among those under age 50. When it comes to the identification of colorectal cancer at an early stage, Texas ranks 49th by the percentage of adults ages 45-75 who reported receiving one or more of the recommended colorectal cancer screening (CRCS) tests within the recommended time interval. Though prevention and early detection have reduced CRC incidence and mortality rates for those ages 50 to 64, not all populations have benefited equally. Screening rates and CRC outcomes rema...

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Need: The five-year survival rate in Texas for those diagnosed with localized colorectal cancer (CRC) is 91%, but only about 35% of CRC is found in this early stage among ages 50 to 64 and only 26% of CRC is localized among those under age 50. When it comes to the identification of colorectal cancer at an early stage, Texas ranks 49th by the percentage of adults ages 45-75 who reported receiving one or more of the recommended colorectal cancer screening (CRCS) tests within the recommended time interval. Though prevention and early detection have reduced CRC incidence and mortality rates for those ages 50 to 64, not all populations have benefited equally. Screening rates and CRC outcomes remain less than optimal for those ages 45-49, the low-income, the uninsured, residents of rural/frontier areas, and African Americans. Overall Project Strategy: Project 80% Colorectal Cancer Screening Program "Project 80%" aims to reduce colorectal cancer morbidity and mortality and promote earlier detection of CRC among uninsured and low-income patients by partnering with Federally Qualified Health Centers (FQHCs) and other non-profit community clinics in rural and urban health professional shortage areas of Texas. The program has successfully met or exceeded its goals through a multi-component intervention implemented at the patient-, clinic- and system level. Project 80% addresses common barriers to CRCS such as cost and accessibility. Strategies include patient reminders; individual and group education; provider reminders, feedback and assessment; and reduction of structural barriers and patient costs. Project 80% offers an initial Fecal Immunochemical Test (FIT) to eligible patients ages 45-75 or direct referrals to colonoscopy for those at increased risk due to a personal history of adenomas or CRC or family history based on the CRCS recommendations of the US Preventive Services Task Force (USPSTF) and US Multi-Society Task Force on Colorectal Cancer (MSTF). Clinic patients with abnormal (positive) FIT results are referred to a community endoscopy provider for colonoscopy and polypectomy, if needed, at no cost to the patient for the clinical services. Surveillance colonoscopy is also provided per physician recommendations. Patients diagnosed with colorectal cancer are navigated to treatment. Our program will provide clinical services in Texas Public Health Regions (PHRs) 2,5, 6, 8,9, and 11. The CPRIT priority populations that are the focus of our program are patients of FQHCs and other non-profit community clinics with lower screening rates and whose patients are uninsured and underinsured individuals The majority of patients are equal to or less than 200% FPL and whose residents live in medically under-resourced communities and nonmetropolitan areas. Most of the patients represented by FQHCs will be racial or ethnic minorities (Black and/or Hispanic). This maintenance expansion project will add four key program components to the current program: 1) Patient Access Expansion with additional active providers increasing access from 51 to 64 counties (map in Figure 1), 2) Lead-Time Messaging around CRC risk and risk-based screening options before recommended screening ages, 3) Quality Improvement training and travel stipend support for clinic staff, and 4) Enhanced Navigation and Follow-up Services that include SMS text patient reminders and transportation services in the geographic service areas of greatest need. Specific Goals: Project 80% Colorectal Cancer Screening Program has three outcome goals. These goals are Goal 1: To increase colorectal cancer screening in CPRIT priority populations through expansion of clinical services in collaboration with community partners; Goal 2: To further strengthen organizational capacity to enhance the use of evidence-based interventions (EBIs) for colorectal cancer screening; and the prepopulated CPRIT goal, Goal 3: To provide navigation services to 100% of patients with positive CRC screening results. Significance and Impact: Over the project period, we estimate that 62,743 patients will complete FITs, and that 5,019 patients will be successfully navigated to colonoscopy. An additional 2,710 patients will have polyps surgically removed (polypectomies). In our network of 176 collaborating clinics, 600 clinic staff will receive provider training on CRCS guidelines, program processes, and quality improvement methodologies. Through a comprehensive approach using EBIs that have previously demonstrated effectiveness in increasing CRCS, Project 80% will continue to assist primary care practices in recommending, promoting, and facilitating increases in CRCS among their patients. Our program covers the cost of the FIT, follow-up colonoscopy, and polypectomy for low-income, uninsured patients. This comprehensive approach is supported by the coordination of community endoscopy providers and enhanced navigation for patients.

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