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2018 Community Grants funded by C4

For 2018, the C4 Board of Directors released a Request for Proposals that was distributed throughout California. The Board agreed to distribute $117,000 for grants that met the competitive review criteria. Twelve proposals were funded and the projects propose to build upon resources available for Californians to ambitiously raise screening rates for colorectal cancer and improve patient outcomes. The project abstracts and funded amounts for 2018 can be accessed through the individual links below:
  1. Champions for Health – San Diego, CA

  2. Family Health Centers of San Diego – San Diego, CA

  3. La Clinica de La Raza, Inc. – Oakland, CA

  4. Lifelong Medical – Berkeley, CA

  5. Neighborhood Healthcare – Escondido, CA

  6. North East Medical Services – San Francisco, CA

  7. Northeast Valley Health Corporation – Sylmar, CA

  8. Operation Samahan, Inc. – San Diego, CA

  9. Redwood Community Health Coalition – Petaluma, CA

  10. Tiburcio Vasquez Health Center – Hayward, CA

  11. University of California San Francisco – San Francisco, CA

  12. Vista Community Clinic – Vista, CA

Champions for Health

Project Title: FIT-San Diego
Project Director: Rebecca Valenzuela, BS
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Cancer Health Care - Delivery; Screening Barriers; Health Communications

Champions For Health Undies 5000 participantsFIT-San Diego will continue to coordinate vital efforts to increase colorectal cancer screening and diagnostics by collaborating with community health centers (FQHCs and free clinics), facilitating access to diagnostic colonoscopies for uninsured adults with a positive FIT test, as well as enhance services by outreaching to adults not connected with a medical home through FluFIT at community based flu immunization clinics. As necessary, we will also coordinate follow-up care including surgery, and cancer treatment utilizing our network of physician volunteers, hospitals, and ancillary health providers.

We will also continue to support area community clinics through health center staff education to improve screening rates among low-income, ethnic, and most vulnerable population. We will continue to host and coordinate an annual meeting with community clinics to share best practices for improving screening and follow-up. We have seen some of our clinic partners more than double their screening rates over the four years we have been involved in this project. We will facilitate in-service training at clinic sites as needed throughout the year, to address clinic staff changes and reinforce best practices.

During this program year, our objectives are to: (1) increase capacity for pro bono colonoscopies for uninsured patients by recruiting and retaining physicians and facilities; (2) assure a minimum of 40 low-income, uninsured adults receive needed diagnostic colonoscopies and follow-up treatment with intensive case management; and (3) facilitate increased screening rates at community clinics through clinic staff education throughout the grant period.

The FIT-SD collaborative expands on an nine-year community partnership which has facilitated 386 pro bono diagnostic colonoscopies and flexible sigmoidoscopies since 2008. As a result of this work, nine cases of colorectal cancer were detected and treated, and numerous polyps were identified and removed, thus preventing the development of cancer. Without access to diagnostics for uninsured patients, community health centers would be severely challenged to provide comprehensive screening for their patients. We are proud of the life-saving results of our partnership with C4.

We are able to accomplish this work thanks to the strong and enduring partnerships we have developed with gastroenterologist specialists who commit to provide pro bono diagnostic and surgical services for uninsured patients without other resources, as well as with facilities who also agree to provide pro bono care. The critical factor to the success with facilitating the care is the intensive patient care management our staff provides to assure patients are educated, properly prepared for procedures, and have barriers to care removed, including transportation and medical interpretation. Our no-show rates for diagnostic colonoscopies is less than 1%, and our provider partners tell us these patients are the best prepared, most compliant of all their patients. We have been fortunate to find surgery and treatment services for all patients diagnosed with CRC over the past nine years due to our long-term partnerships.

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Family Health Centers of San Diego

Project Title: Increasing CRC Screening Rates among Underserved Populations
Project Director: Tony De Los Santos, MPH, MSW
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Screening Barriers

Family Health Centers of San Diego (FHCSD) aims to decrease mortality associated with colorectal cancer and increase colorectal cancer screening rates for adults age 50-75 at our North Park Family Health Center (NPFHC). FHCSD proposes to increase CRC screening rates at NPFHC from a baseline of 41.66% to 48% over a one-year period (by February 28, 2019) through the strategic efforts of a culturally- and linguistically- competent Patient Navigator (PN). In addition, through the work of the Patient Navigator FHCSD aims to increase access to care for patients with abnormal FIT results by increasing the percentage of these patients who receive diagnostic evaluation, and decreasing the time from identification of the abnormality to diagnostic resolution of the abnormality.

NPFHC serves our region's low-income and culturally-diverse populations. Eighty-nine percent of the clinic's patients are low-income, and 72% are considered impoverished, with incomes at or below 100% of the FPL. Approximately 77% of NPFHC's patients are people of color, including 46% Hispanic, 11% African American, 3.3% Asian/Pacific Islander, and 16.4% multi-racial or other. Patients at NPFHC experience tremendous barriers to completing CRC screening, including limited English proficiency, low health literacy, lack of knowledge of the benefits of screening, in addition to pervasive fear often culturally-influenced around receiving a cancer diagnosis.

As a result of the complex and overlapping barriers experienced by many NPFHC patients, NPFHC has lower-than-average CRC screening rates. In fact, as FHCSD aims to achieve 80% screening rates by 2018, FHCSD's agencywide rate is 46.42%, and NPFHC's rate is 41.66%. The clinic has implemented a number of process improvements over the last three years to address its lower-than-average CRC screening rate, however additional capacity and resources are needed to continue to improve the screening rate and thus reduce disparities in CRC screening, diagnoses and treatment among NPFHC's adult patients.

FHCSD proposes to add a 0.25 FTE Patient Navigator to NPFHC's clinical team to specifically address CRC screening rates and diagnostic evaluation among underserved patients. The PN will (a) ensure adult patients receive both a FIT kit and culturally- and linguistically-appropriate education about screening, (b) provide follow-up and navigation for patients with incomplete screens or who are high-risk and need a referral for colonoscopy, and (c) provide intensive assistance for patients with abnormal screening results, to ensure they successfully access diagnostic evaluation services.

The proposed project will leverage significant in-kind resources, including lessons learned by FHCSD in our implementation of C4-funded patient navigator programs at our Chase Avenue and Chula Vista Family Health Centers (in 2015 and 2016, respectively). The project also will benefit from the University of California San Diego (UCSD)/ San Diego State University (SDSU) Cancer Center Comprehensive Partnership, a National Cancer Institute (NCI)-funded research team that, in partnership with FHCSD, is building on recommended intervention strategies described in the Guide to Community Preventive Services to ensure complete diagnostic follow-up for patients with abnormal cancer screening tests.

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La Clinica de La Raza, Inc.

Project Title: Coordinated Colorectal Cancer Screening Project
Project Director: Junelle Palec
Total Grant Amount Funded: $8,000
Priority Area: Primary Prevention and Screening; Screening Barriers; Health Communications

In 1971, La Clínica de La Raza began providing high quality, culturally and linguistically appropriate services to low income residents of Alameda County. La Clínica has since expanded to serve patients in 34 sites across Alameda, Contra Costa and Solano Counties and remains dedicated to the principles on which it was founded. La Clínica is proposing to implement the Coordinated Colorectal Cancer Screening Project in order to improve screening rates in patients served at La Clínica's Vallejo Medical Clinic.

Ethnic minorities bear an unequal burden of colorectal cancer and are less likely to be screened for colorectal cancer. The Colorectal Cancer in California 1988-2012 report (2016) indicates that, colorectal cancer incidence rates in African American men are significantly higher (61.3 per 100,000) as compared to non-Hispanic whites (36.2 per 100,000) (p.4-5). Similarly, colorectal cancer mortality rates are higher in African American men than in non-Hispanic white men, 26.0 per 100,000 vs. 16.5 per 100,000 respectively. Non-Hispanic Black women experience similar colorectal cancer incidence and mortality disparities as compared to non-Hispanic white women, (Colorectal Cancer in California 1988-2012, p. 11). Additionally, Hispanics 50 years of age and older are less likely to have had a recent screening test for colorectal cancer than non-Hispanic whites, 46% vs. 68.9% respectively (Colorectal Cancer in California 1988-2012, p. 17). This funding will greatly enhance La Clínica's ability to address and lessen colorectal cancer screening disparities experienced by our patients.

Access to colonoscopy services for cancer screening is a barrier to screening for many of La Clínica's patients. Use of Fecal Immunohistochemical Tests (FIT) have improved overall screening rates agency wide. In 2015 agency-wide 35% of all eligible patients age 50-75 were screened for colorectal cancer (CRC) which improved to 43% in 2016 by emphasizing FIT for screening. At La Clínica's Vallejo Medical Clinic, 23% (n=351) of all eligible patients (n=1534) completed a FIT for CRC screening. The overall objective of this Coordinated Colorectal Cancer Screening Project is to put a system in place at La Clínica Vallejo Medical Clinic to pair education and distribution of FIT kits with flu vaccination in order to increase FIT completion rates to 30% or 460 completed tests during the project period.

The overall objective of this project will be achieved through activities for clinic workflow development, patient education, staff training, and workflow implementation. Reports will be developed to identify patients with a cap in CRC. This gap in care report will be integrated into the Care Team workflow. Staff will be trained on patient education process and workflows to pair FIT distribution with flu vaccination. Staff will implement the workflows and screening rates will be monitored. Staff feedback will be solicited and testing rates shared in an iterative process to refine the workflow to achieve the objective of increasing FIT completion rates by 10% during the funding period. The long term goal is to institutionalize the process of pairing FIT distribution with flu vaccination and integrate that process agency wide.

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LifeLong Medical Care

Project Title: Increasing Follow-Up Rates from Positive FIT Tests
Project Director: Nermeen Iskander, MA
Total Grant Amount Funded: $10,000
Priority Area: Cancer Health Care - Delivery; Screening Barriers

LifeLong Medical Care (LifeLong) is a Federally Qualified Health Center (FQHC) serving more than 60,000 individuals of all ages in Alameda, Contra Costa, and Marin Counties. As a safety-net provider of medical, dental, and behavioral health services, LifeLong is dedicated to reducing health disparities among underserved populations. Our mission is to provide high-quality health and social services to underserved people of all ages; create models of care for the elderly, people with disabilities and families; and advocate for continuous improvements in the health of our communities.

Since 2015, LifeLong has focused on improving colorectal cancer screening rates by increasing awareness, building systems improvements, and conducting site-based improvements. Screening patients using the fecal immunochemical test (FIT) has been our primary goal. For this project, however, LifeLong will improve colonoscopy follow-up rates for patients who have screened positive with a FIT.

With support from C4, Lifelong will identify patients with positive FIT results, alert providers who have not initiated colonoscopy referrals, and follow-up with patients to complete these referrals. Staff will be engaged to will track, test and refine process improvements to increase colonoscopy follow-up rates for colorectal cancer screening.

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Neighborhood Healthcare

Project Title: FIT San Diego - Neighborhood Healthcare
Project Director: James Schultz, MD, MBA, FAAFP, DiMM
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Cancer Health Care - Delivery; Screening Barriers

FIT San Diego is a partnership between the San Diego County Medical Society Foundation (SDCMSF) (lead agency), Kaiser Permanente, and four community clinics in San Diego County, including Neighborhood Healthcare. Our partnership's goal is to increase screening among all eligible populations, with a focus on high-risk populations, such as the Latino and African American male population. Neighborhood Healthcare (NHcare) is committed to the National Cancer Colorectal Roundtable initiative 80% by 2018 whose shared goal is 80% of adults aged 50 and older are being regularly screened for colorectal cancer by 2018.

NHcare is partnering with the University of California, San Diego (UCSD) Moores Cancer Center to identify additional policies and interventions that promote diagnostic colonoscopy among individuals with abnormal FIT. A joint research project in 2015-2016 found that uptake of diagnostic colonoscopy after abnormal FIT was low. NHcare is now focused on the long-term goal of increasing the percentage of patients with an abnormal FIT test that follow-through with a colonoscopy.

Strategies to achieve these goals will include:

  1. Holding each care team accountable for CRC recommendations by providing monthly data on their paneled patients and incentives for milestones;
  2. Continuing to conduct population health activities such as conducting reminder calls for patients to bring back the FIT kit;
  3. Including FIT reminders in a patient text campaign;

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North East Medical Services

Project Title: NEMS CRC Screening Rate for Low Income Asian Populations
Project Director: Eddie W. Chan, Pharm.D.
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Screening Barriers; Psychosocial/Cultural and Survivorship Issues; Health Communications

Doctor with fit kitNorth East Medical Services (NEMS) is a federally qualified health center with twelve locations in the San Francisco Bay Area. The organization is one of the largest health centers in the nation targeting the medically underserved Asian population. Of the 66,652 patients served at NEMS each year, over 90% are Asian, 62% participate in Medi-Cal (Medicaid), and 11% are uninsured. Because colorectal cancer (CRC) is the second most common diagnosed cancer and the third highest cause of cancer-related mortality among Asian Americans, NEMS has made colorectal cancer screening an organization-wide priority.

The "NEMS CRC Screening Rate for Low Income Asian Populations" Project aims to increase the colorectal cancer screening rate compliance of the clinic's patients, ages 50 to 75, from 80% to 82% by the end of the grant period, which can potentially impact up to 19,300 adults in this age range. The proposed project uses multiple evidence-based interventions recommended by the U.S. Preventive Services Task Force (USPSTF) to increase CRC screening rates, including: the distribution of multilingual educational materials on colorectal cancer and screening; outreach to patients through in-person counseling, reminder letters, and phone calls; and the direct mailing of free FIT kits to patients's homes to reduce barriers to access. Promoting CRC screenings, in particular simple screening methods such as the one-sample FIT test, is an effective means of promoting access to preventive health care services, particularly for low-income and uninsured patients.

Because of the lack of access to and cultural hesitations towards colonoscopy and sigmoidoscopy procedures, NEMS has found that simple testing options and ongoing, persistent education and encouragement has been most impactful among our patient community. Since 2014, NEMS has made it an organizational goal to improve or maintain high colorectal cancer screening rates, despite the laboriousness of ongoing, annual patient reminders and testing that must occur. Over the last three years, rates have improved from 55.4% at the beginning of 2014 to 80.0% as of November 2017. NEMS's long term objectives is to continue emphasizing and promoting the importance of colorectal cancer screenings so that the practice becomes second-nature to patients.

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Northeast Valley Health Corporation

Project Title: Increasing Colorectal Cancer Screening (ICCSR)
Project Director: Robert Veliz, MPH
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Screening Barriers

Northeast Valley Health Corporation (NEVHC), a non-profit, Joint Commission Accredited Federally Qualified Health Center (FQHC) serving medically underserved residents of the San Fernando and Santa Clarita Valleys in Los Angeles County, respectfully requests $10,000 from the California Colorectal Cancer Coalition to help improve the health outcomes of our predominantly Latino patients by improving the percentage of patients that return a completed Fecal Immunochemical Test (FIT) kit.

More specifically, your funds will support staff training and supplies needed to increase the percentage of NEVHC's 10,142 patients 50-75 years of age that complete colorectal cancer screening from a baseline of 50.2% in October 2017 to 64.1% by February 2019. To do so, NEVHC will focus efforts on interventions that increase the number of FIT kits distributed at the Point of Care and increase the percentage of patients returning FIT kits through patient recall interventions.

Our first objective is to increase the percentage of FIT kits distributed at Point of Care at NEVHC health centers. In order to so, the NEVHC Quality Improvement team will conduct training sessions with lab staff at eight NEVHC health centers that will emphasize the importance of timely colorectal cancer screening, proper test kit documentation, as well as review "missed opportunities" data on distributing FIT kits at the health centers.

Our second objective is to increase the percentage of patients who return their FIT kits. In order to improve our FIT kit return rate, Volunteer Student Interns will send reminder letters and conduct phone calls to patients who have not returned their kits. The reminder letters as well as the phone calls will provide patients the opportunity to receive additional colorectal cancer screening education and request another FIT kit if needed.

I2iTracks, an automated patient population management system that is interfaced with NextGen, our electronic health record system, will be used to help conduct and track program activities.

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Operation Samahan, Inc.

Project Title: Samahan Colon Cancer Screening Program
Project Director: Dr. Trish Ghosh
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening

The proposed project aims to enhance Operation Samahan, Inc.'s colon cancer screening rate from 40% to 60% by expanding accessibility, awareness, and utilization of FIT test tool kit within two of OSI's new clinic sites: Rancho Penasquitos and Erma Road Health Centers. By the end of the funding period, OSI would have screened at least 100 eligible uninsured patients and for those needing additional care, the program would have provided timely and affordable follow-up and treatment. The program will replicate best practices and lessons learned from the two OSI successful sites that implemented similar C4 screening programs in the past.

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Redwood Community Health Coalition

Project Title: Improving Colorectal Cancer Screenings
Project Director: Michelle A Rosaschi, MPH
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening

The Redwood Community Health Coalition (RCHC) aims to achieve an overall 3% improvement in colorectal cancer (CRC) screening rates in adults ages 50-75 by December 31, 2018 utilizing RCHC's 4-Point Evidence-Based Care (EBC) program to improve CRC screenings across participating member community health centers. Annual UDS reporting to HRSA will be used to track progress from our baseline of 44% in 2016. RCHC will track and document 2017 UDS CRC screening rates and 2018 preliminary UDS reporting data will be used to measure performance for our final evaluation of the project. RCHC's project focuses on our EBC program to improve CRC screenings in health centers through: 1) shared clinical guidelines, 2) clinical decision support (CDS) in the EHR to reinforce the evidence-based guidelines and standardized analytics/reports, 3) sharing of best practices through regular peer network meetings, and 4) quality improvement and population health management support through trainings on motivational interviewing, health coaching and panel management. Specifically this grant will support RCHC's development and deployment of standard clinical decision support tools to reinforce the evidence-based clinical guideline and support improvements in CRC screenings and diagnosis. Health centers will document and share promising practices including PDSAs. RCHC will provide annual summary dashboards to track progress over time and compare performance across health centers. This project aligns with RCHC's Health Resource Services Administration (HRSA) Health Center Controlled Network (HCCN) grant which includes colorectal screenings as one of five clinical focus areas. Standardizing CDS such as templates, order sets, alerts, recalls and reports across our network will facilitate improvements in CRC screening rates across our region.

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Tiburcio Vasquez Health Center

Project Title: Colorectal Cancer Prevention Project
Project Director: Porshia Mack, MD
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Screening Barriers; Health Communications

The long term objectives of the proposed colorectal cancer prevention project are to 1) address Tiburcio Vasquez Health Center's gap in services for early colorectal screening and 2) improve our current rates of providing fecal immumunochemical test ("fit") kits to all eligible patients; supporting patients in completing and returning the fit kits; and referring clients for colonoscopy when it is needed.

The long term objectives of the proposed colorectal cancer prevention project are to 1) address Tiburcio Vasquez Health Center's gap in services for early colorectal screening and 2) improve our current rtates of providing fecal immumunochemical test ("fit") kits to all eligible patients; supporting patients in completing and returning the fit kits; and referring clients for colonoscopy when it is needed.

The specific aim of the project is to increase the percentage and number of Tiburcio Vasquez Health Center's patients to be screened for colorectal cancer. We aim to increase baseline screening rates from 32% to 50%, and raise the baseline percentage of returned fit tests from 53% to 60%.

The project will serve Tiburcio Vasquez Health Center's patients at four primary care clinics, who are at average risk for developing colorectal cancer. The proposed project will increase the number of Tiburcio Vasquez Health Center's patients 50-75 years of age being given and completing kits, and to improve colorectal cancer screening rates.

As said, only 32% of Tiburcio Vasquez Health Center's eligible patients are currently being given kits by physicians or medical assistants, with just 53% of those patients returning the kits.

This gap in services spurred us to develop a three-part project to significantly increase the percentage of eligible Tiburcio Vasquez Health Center patients who are given the fit kits, and also the percentage who complete and return them. In this way we can boost the detection of colorectal cancer early, preventing our patients - mainly low income hispanic men and women -- from dying of the disease.

To accomplish our goal, we will:

  1. Host for our staff members quarterly inservice trainings developed with our partners at the Amercian Cancer Society, on colorectal cancer, screening recommendations, and delivery of liguistically and culturally appropriate fit test instructions.
  2. Develop and print a simple flyer in English and Spanish, with culturally and liguistically sensitive instructions at a fourth grade reading level, designed to support patients in completing and returning the fit kits.
  3. Assign to each of the four health center's clinical services coordinator at .15 fte (six hours weekly) to make contact with patients one week after they have been given the fit test, answer any questions they may have, and encourage them to promptly complete and return the fit kit.

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University of California San Francisco

Project Title: Reducing barriers to colonoscopy for +FIT patients
Project Director: Shreya Patel, MD MPH and Patrick Avila, MD MPH (co-directors). Ma Somsouk MD MAS (sponsoring PI)
Total Grant Amount Funded: $9,000
Priority Area: Primary Prevention and Screening; Cancer Health Care - Delivery; Screening Barriers; Health Communications

The San Francisco Health Network (SFHN) is a safety-net health system that serves a population of low income and diverse patients in San Francisco with a high proportion of Medicaid recipients, patients with limited English proficiency and low health literacy. SFHN utilizes a fecal immunochemical test (FIT) based colorectal cancer (CRC) screening strategy. Within the SFHN, there are approximately 10,000 FIT tests performed annually resulting in 500 abnormal FIT results per year. (1) All clinics refer patients with an abnormal FIT result to one gastroenterology practice for colonoscopy. (1) Critical to a FIT screening strategy is colonoscopy follow-up for abnormal FIT results. Indeed, missed or delayed colonoscopy follow-up for abnormal FIT testing increases CRC-mortality by 1.64-fold. (2) Currently, within SFHN, completion of colonoscopy after an abnormal FIT remains poor, with a recent study showing ~50% of patients completed a colonoscopy within a year of a positive FIT test between 2012-2015. (1)

The primary objective of our project is to improve the completion of colonoscopy follow-up after an abnormal FIT result through the design and implementation of patient centered and culturally sensitive multimodal technology-enhanced communication. This communication will take form as mailed informational packets, automated SMS-delivered patient support, and/or automated telephone reminders. While previous research has shown that patient navigators can improve colonoscopy completion after an abnormal FIT the cost to employ sufficient navigators to manage a large of number of patients is challenging in resource limited settings such as a safety-net health system. (3) Clearly, then, there is a need for low-cost and scalable intervention to help patients navigate the process from an abnormal FIT result to colonoscopy. Furthermore, previous research has shown that a clear majority of safety-net patients report high interest in using technology for support of self-management. (4)

We will develop and pilot test the effects of enhanced patient communication with mailed informational packets, automated SMS-delivered patient support and/or automated telephone reminders with usual care. After patients are electronically referred to the GI practice patients will be asked their preferred form of communication besides mailed instructions (voice and/or text messaging). Those in the enhanced communication arm will receive culturally sensitive and language-concordant instructional mailings about meaning of positive FIT, colonoscopy, and bowel prep instructions. They will also receive language-concordant automated text-messages and/or phone calls reminding patients about their appointment, prompting them to pick up their bowel prep, and advising them through the prep process. During each text message exchange, patients have the opportunity to receive a call-back from a GI nurse for more information. We will collect information on colonoscopy utilization, quality of bowel preparation and conduct patient experience surveys. The primary outcome will be completion of colonoscopy among usual care and the enhanced communication arm. In addition to improving colonoscopy completion we hypothesize that enhanced communication/automated patient navigation is a low cost and sustainable intervention that will improve colonoscopy preparation and enhance patient experience. Solutions identified will be shared and disseminated.


  1. Issaka RB, Singh MH, Oshima SM, et al. Inadequate utilization of diagnostic colonoscopy following abnormal FIT results in an integrated safety-net system. Am J Gastro. 2017; 112; 375-382.
  2. Corley DA, Jensen CD, Quinn VP, et al. Association between time to colonoscopy after a positive fecal test result and risk of colorectal cancer and cancer stage at diagnosis. JAMA. 2017; 317(16); 1631-1641.
  3. Selby K, Baumgartner C, Levin TR, Doubeni C, Zauber AG, Schottinger J, Jensen CD, Lee JK, Corley DA. Interventions to improve follow-up of positive results on fecal blood tests: A systematic review. Annals of Internal Medicine 2017:DOI: 10.7326/m17-1361.
  4. Sarkar U, Piette JD, Gonzales R, Lessler D, Chew LD, Reilly B, Johnson J, Brunt M, Huang J, Regenstein M, Schillinger D. Preferences for self-management support: findings from a survey of diabetes patients in safety-net health systems. Patient Educ Couns 2008;70:102-10.

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Vista Community Clinic

Project Title: Promoting Continuous Improvement in FIT Screening Compliance
Project Director: Kelly, C, Motadel, MD, MPH
Total Grant Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Screening Barriers

Vista Community Clinic's (VCC) struggles to improve CRC screening rates reflect a lack of preventive health consciousness among patients; an influx of newly insured patients with multiple problems, leaving little time to focus on preventive measures; and the reality that, while VCC is developing a clinical culture in which promotion of FIT test use and return features prominently, the organization is still working to institutionalize that culture and its related practices.

With the assistance of C4, and the efforts that VCC has undertaken and is currently executing to promote FIT test distribution and return, VCC has made significant strides during this project year. The creation of a short-term Quality Assurance Clerk position to evaluate VCC's FIT test-related practices, and to work with both front and back-office staff in improving those practices, has led to a significant improvement in testing rates this year, moving VCC from 40% to 50% compliance. With the leadership of the Quality Assurance Clerk, in conjunction with VCC's Cancer Screening Committee, related policies have been rewritten and procedures streamlined, staff in all VCC clinical locations have received additional training and have improved their processes for distributing FIT kits, while new and more culturally accessible materials have been developed to better explain the process, and VCC believes that it has created a more usable kit. The practice of reviewing appointment lists the following day for missed opportunities also has been put into practice. Missed opportunities have decreased substantially as a result.

With this request, VCC wishes to accomplish two things. First, and in the context of supporting current work, this request will fund another time-limited period of effort on the part of the Quality Assurance Clerk (QAC) position. The QAC will continue to work with key staff at each clinic location to further promote a culture in which 100% of relevant patients will receive a FIT test kit and adequate, culturally and linguistically relevant education; and every patient receiving a kit will also receive adequate follow-up contact to promote kit completion and return.

In addition, VCC will use these funds to automate processes to note missed opportunities for CRC screening in clinic, and to remind patients to return their FIT tests. The automation of these processes, which will involve one of VCC's IT experts developing a report template, will reduce the amount of staff time needed to flag these missed opportunities, and will provide clinic staff with more immediate feedback regarding these missed opportunities, feedback that they can use to review their own practices and departures from standard processes, and improve those processes and related colorectal cancer screening outcomes. The IT expert also will develop a process for automating patient reminders that prompt patients who have received FIT kits to complete the test and return the samples. Taken together, the work of the QAC and these two IT solutions will help VCC increase the number of patients screened for colorectal cancer to meet the 80% by 2018 goal.

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