Grants
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2016 Community Grants funded by C4

For 2016, the C4 Board of Directors released a Request for Proposals that was distributed throughout California. The Board agreed to distribute $85,025 for grants that met the competitive review criteria. Of the sixteen proposals reviewed, ten proposals were funded. 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 2016 can be accessed through the individual links below:
  1. Lifelong Medical – Berkeley, CA

  2. UC San Francisco – San Francisco, CA

  3. Vista Community Clinic – Vista, CA

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

  5. United American Indian Invovlement – Los Angeles, CA

  6. San Diego Medical Society Foundation – San Diego, CA

  7. Vietnamese American Cancer Foundation – Fountain Valley, CA

  8. Operation Samahan – National City, CA

  9. Neighborhood Healthcare – Escondido, CA

  10. White Memorial Medical Center – Los Angeles, CA

LifeLong Medical

Project Title: Improving Safety-Net Colorectal Cancer Screening
Program Director: Nermeen Iskander
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening
Relationship to Colorectal Cancer: Colorectal Cancer Screening

LifeLong Medical Care (LifeLong) is a Federally Qualified Health Center (FQHC) that serves more than forty-thousand individuals of all ages in Alameda, Contra Costa, and Marin Counties. As a safety-net provider of medical, dental and social 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.

LifeLong will improve colorectal cancer screening rates at two of LifeLong’s health centers: LifeLong Over 60 Health Center and LifeLong Howard Daniel Clinic. By building awareness, making systems improvements, and conducting site-based improvements, we will increase colorectal cancer screening rates from 18% to 35% by the end of 2016.

This project will focus on reaching out to patients who are coming in for primary care visits. A panel manager at each site will use Health Information Technology to identify and track patients who are due for a screening. Medical assistants will educate patients on the importance of colorectal cancer screenings and how to properly use Fecal Immunochemical Test (FIT) kits. If lab results return positive, providers will educate patients on follow-up steps and refer patients for a colonoscopy.

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UC San Franciscso

Project Title: FluFIT Program Website Enhancements
Program Director: Michael B. Potter, MD
Total Gran Amount Funded: $3,000
Priority Area: Primary Prevention and Screening
Relationship to Colorectal Cancer: Average Risk Screening

The FluFIT program (flufit.org) is an evidence-based colorectal cancer screening program that enables clinical teams to leverage annual flu shot campaigns as an opportunity to offer colorectal cancer screening with FIT to eligible average risk patients. The website was last updated about 3 years ago, and since that time there have been new USPSTF screening guidelines, a new "80 by 18" initiative sponsored by the National Colorectal Cancer Roundtable, new CME programs from the CDC that incorporate information about the FluFIT Program, new initiatives sponsored by the American Cancer Society using the FluFIT Program, and other spontaneous uses and adaptations of the FluFIT Program, such as by Kaiser Permanente's Northwest Region and by "FluFIT on the Frontera", a program combining FluFIT activities with traditional patient navigation on the Texas-Mexico border.

While we have been able to add information about some of these activities to the website on a piecemeal basis, we feel it is time to do a more comprehensive update. In addition to updates and information already mentioned, we plan to use this opportunity to survey a select group of users of the program for feedback on the website and for stories that can be shared on the website, and we hope to develop a national cadre of experienced FluFIT Program users who can serve as mentors for new users of the program. We also hope to enlist C4 as an ongoing supporter of this program, promoting the FluFIT program as an official C4 program to primary health care settings across the state of California.

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Vista Community Clinic

Project Title: Improving CRC screening rates of community clinic patients
Program Director: Kelly, C, Motadel, MD, MPH
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Screening barriers
Relationship to Colorectal Cancer: Average Risk Screening

While Vista Community Clinic (VCC) has followed the U.S. Preventive Task Force recommendation that all patients ages 50-75 with normal colorectal cancer (CRC) risk be screened annually, VCC's CRC screening rates historically have been quite low. VCC's baseline screening figure prior to receipt of C4 funding this year was 10.5%, set against the national CRC health clinic screening average rate of 33%. With VCC's receipt of C4 funding in 2015, and implementation of a variety of process improvement measures, VCC's screening rate had improved to 25.6% by September 2015. Prior to initiation of these improvements, VCC had identified the reasons for its low rates as: a lack of preventive health consciousness among many of its patients; an influx of newly insured patients with multiple, significant problems, affording little time to providers to focus on preventive measures; the onerous nature of the FOBT that VCC was then using; the lack of an electronic prompt to remind the care team to promote CRC screening test use; and the lack of a comprehensive and consistently applied patient education plan.

With the support of C4, VCC has dedicated itself to improving CRC screening rates, with a goal ultimately of meeting or exceeding the national average. Toward this end, VCC has ceased use of the GUIAC test in favor of the FIT test; improved patient education regarding the FIT test’s purpose and how to use it; initiated a process to improve labeling of individual tests to ensure proper processing of tests and timely receipt of test results; unbundling of tests ordered coupled with training of appropriate staff, to counteract the prior experience in which patient tests were marked 'complete' before CRC screening results were completed, leading to the loss of those results; the assignment of a Provider Champion at each site to ensure proper application of new protocols and to motivate staff related thereto; and the use of a new HEDIS template within the EHR that lists CRC screening patients ages 50+, and notes fulfillment (or lack thereof) of this measure. With the continued support of C4, VCC will create a clinical cultural in which the promotion of CRC screening is automatic, FIT testing is expected among the target population, and patients become promoters of CRC testing within their social networks. Patients screening positive will receive support from VCC Referral Coordination staff, which will refer to providers that accept Medi-Cal and uninsured patients.

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Family Health Centers of San Diego

Project Title: Patient Navigation Intervention to Enhance Screening and Overcome Barriers for Underserved Populations
Program Director: Molly M. Reed
Total Gran Amount Funded: $8,975
Priority Area: Primary Prevention and Screening; Screening barriers
Relationship to Colorectal Cancer: Screening Enhancement and Patient Navigation

The Chase Avenue Family Health Center, one of 21 clinics (18 fixed site and three mobile) in the Family Health Centers of San Diego system, cares for a primarily low-income (81.8% live below 100% of the Federal Poverty Level), ethnically-diverse clientele (51.5% Hispanic, 33.2% white, 8.2% black, 3.2% Asian/Pacific Islander, 0.7 Native American, and 3.2% more than one race).

This population is traditionally very challenging when it comes to cancer screening, especially for Colorectal Cancer (CRC), due to a variety of environmental and personal barriers. These may include a high percentage of monolingual Spanish and Arabic speakers, lack of transportation, lack of trust in healthcare providers, cost, fear of the process, and a general lack of knowledge of disease risk, screening benefits and needs, and where and when to get recommended cancer screening. Of the more than 2,500 patients between the ages of 50 and 75 who consider CAFHC their medical home, less than ⅓ are up-to-date with current CRC screening recommendations.

Over the past year, Chase Avenue Family Health Center has been implementing a number of quality improvement efforts to identify and impact root barriers to screening completion, with modest success. This project will add a 0.2 FTE Patient Navigator to these ongoing efforts, to provide more intensive follow-up for patients who are lost to care, have incomplete screens, or who are considered high risk and need referral for colonoscopy. The Patient Navigator will also provide individual assistance for patients with an abnormal screen, a critical need for our patients.

The Patient Navigator will have the opportunity to learn from and work with a National Cancer Institute (NCI) funded research team that is building on recommended intervention strategies described in the Guide to Community Preventive Services, in order to meet the needs of an underserved, diverse, low-resource patient population. By implementing culturally-appropriate patient navigation interventions within a high-quality service system, it is expected that screening completion rates will increase by 25% by the end of the project period.

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United American Indan Involvement

Project Title: UAII CRC- PHASE Project
Program Director: Serena C. Marquez, MPH, BA
Total Gran Amount Funded: $5,300
Priority Area: Primary Prevention and Screening; Screening barriers
Relationship to Colorectal Cancer: Average Risk Population Screening

Background:
United American Indian Involvement (UAII) is a 501 (c)3 private, nonprofit organization offering a wide array of health and human services to the American Indian/ Alaskan Native (AI/AN) community residing throughout Los Angeles County. UAII was established in 1974 and has grown from a small community based organization to a multidisciplinary comprehensive center that meets multiple needs of AI/AN countywide. The mission of UAII is to promote and support the physical, behavioral and spiritual well-being of AI/AN in the urban Los Angeles area by providing comprehensive, integrated services that promote healthy lifestyles and individual responsibility in order to strengthen AI/AN communities.

Specific Aim:
For the year 2016 grant period, UAII will seek to target a minimum of 150 clients (20%) of entire target population (743 registered AI/AN clients between the age range of 50-75 year) to provide education and screening for colorectal cancer.

Process:
The purpose of the UAII CRC PHASE (Prevention, Health Awareness, Screening, and Education) project is to increase Colorectal Cancer Screening among American Indian / Alaska Natives (AI/AN) age 50 years or older. With Funding from the California Colorectal Cancer Coalition (C4), the project will increase awareness of Colorectal Cancer and the necessity of Colorectal Cancer Screening as part of primary prevention and detection in primary care. This project will serve as a model for enhancing colorectal cancer screening services, reducing screening barriers, and increasing follow-up and reminder systems as well as resolving issues of low return rates regarding FIT Kits. To this end UAII will increase access to FIT kits, educate patients and the community, and improve the internal Colorectal Cancer systems integration to increase the rate of screening compliance.

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San Diego Medical Society Foundation

Project Title: FIT-SD
Program Director: Barbara Mandel, MBA
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening, Cancer Health Care – Delivery, Screening Barriers, Health Communications
Relationship to Colorectal Cancer: Colorectal cancer, Average Risk Population Screening, CRC Diagnostics, Precancerous lesions, High Risk Screening, CRC Treatment/Therapeutics

FIT-SD will coordinate county-wide efforts to increase colorectal cancer screenings at federally qualified health centers (FQHC), and improve access to diagnostics and treatment for low-income, uninsured San Diego County residents, with a focus on high risk populations such as Latino and African American males. The program will expand on a state model for improved colorectal cancer outcomes, by convening the following regional healthcare partners:

  • Community clinics - Neighborhood Healthcare; Operation Samahan; San Diego Family Care; San Ysidro Health Center; Vista Community Clinic; North County Health Services. All FQHCs and free clinics will be invited to attend and learn from grantees’ best practices.
  • Medical Centers - Kaiser Permanente and Tri-City Medical Center.
Through California Colorectal Cancer Coalition’s (C4) support, SDCMS Foundation currently:
  1. Provides training, education and support to assist clinics increase usage of non-invasive Fecal Immunochemical Tests (FIT) as a primary screening tool for colorectal cancer.
  2. Facilitates pro bono diagnostics/treatment with medical centers, through Project Access San Diego (PASD). PASD also coordinates free enabling services for patients to overcome screening barriers (e.g. transportation, medical interpretation, medication assistance).
  3. Monitors proper data and test collections, and follow-through.

The FIT-SD collaborative expands on a six-year partnership between SDCMS Foundation and Kaiser Permanente, which has facilitated 195 pro bono diagnostic colonoscopies and flexible sigmoidoscopies, with 15 cancers prevented through polyp removal, two cancers caught, and only five PASD patients required surgery, all successfully treated. In 2015, PASD expanded this collaborative to include Tri-City Medical Center providing pro bono diagnostics, and will continue recruiting more physician/medical volunteers. PASD’s bilingual patient care managers act as liaison between uninsured patients, their referring clinic, and physician/medical volunteers, and are responsible for facilitating all aspects of pro bono diagnostics and treatment.

Utilizing best practices from American Cancer Society and C4, FIT-SD will host a roundtable to present to Chief Medical Officers and cancer champions of community clinics the results of the 2015 clinic experience, proven methods to improve clinic in-reach, and outreach strategies to increase FIT screening and test return. SDCMS Foundation will lead in facilitating this event.

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Vietnamese American Cancer Foundation

Project Title: Colorectal Cancer Project
Program Director: Becky Nguyen, MPA, MPH
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening, Screening Barriers, Psychosocial/Cultural and Survivorship Issues, Health Communications
Relationship to Colorectal Cancer: Colorectal Cancer, Average & High Risk Population Screening, Quality of Life/Survivorship, Patient Navigation, Referrals & Care Coordination

The Vietnamese American Cancer Foundation's (VACF) mission is to prevent cancer, improve patient quality of life, and save lives through cancer education, research, advocacy, and services in the Vietnamese American community. In line with its mission and those of the California Colorectal Cancer Coalition, VACF's Colorectal Cancer Project strives to increase colorectal cancer knowledge, awareness, and screening compliance for an underserved and underinsured population in Southern California. The Project will aim to provide in-depth and culturally and linguistically-tailored community seminars, disseminate FIT kits with an 80% return rate, and provide patient navigation and individualized follow-up for people with abnormal results.

VACF's Colorectal Cancer Project will comprise of the following activities:

  1. Translate and produce a bilingual colorectal cancer informational brochure and collection of community resources to help those with colorectal cancer
  2. Host four (4) half-hour radio shows on ethnic stations. The radio shows will feature a local gastroenterologist who will provide an overview of colorectal cancer facts and recruit individuals to attend the Colorectal Cancer Project’s community education seminars.
  3. Facilitate two (2) culturally and linguistically appropriate community educational seminars and distribute FIT kits for about 100 participants at each event. Seminars will go in depth into colorectal cancer facts, risks, and the importance of early screening. Each event will be paired with a follow-up meeting a couple of weeks after to explain results for those with a positive FIT result.
  4. Conduct patient navigation to link participants to colorectal screening services in the community. VACF will continue to perform care coordination for the patient if he/she has a screening result that needs further follow-up.
The Vietnamese American Cancer Foundation (VACF)'s mission is to prevent cancer, improve patient quality of life, and save lives through cancer education, research, advocacy, and services in the Vietnamese American community. VACF was founded in 2002 by local cancer survivors, physicians, and volunteers who recognized the need for culturally and linguistically appropriate cancer support and resources in the underserved Vietnamese American community. In 13 years, VACF has grown to be an integral and reputable organization that continues to provide strong cancer care coordination and patient navigation, along with health education and cancer prevention in the broader community.

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Operation Samahan

Project Title: FIT-SD: Operation Samahan
Program Director: Fe Seligman
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening, Cancer Health Care – Delivery, Screening Barriers, Health Communications
Relationship to Colorectal Cancer: Colorectal cancer, Average Risk Population Screening, CRC Diagnostics, Precancerous lesions

Operation Samahan,Inc. in 2014 received funding from FIT-SD to improve its colon cancer screening rates among its high-risk Latino and Filipino/Asian patients. During the past two years, FIT-SD assisted Operation Samahan, Inc. to build its capacity to conduct community education primarily in National City on colorectal cancer screening awareness using FIT kits. As a result of the partnership, the overall colon cancer screening rate spiked from a meager 2.5% in 2013 to an impressive 31% in 2015.

Through this funding opportunity, Operation Samahan will continue to work with FIT-SD to improve screening and FIT kits return rate; improve follow up for FIT testing through staff training; as well as provide timely provision and continuity of care through direct referral of eligible patients who need treatment and specialty care.

The goal for this cycle will be to:

  • Increase screening rate from 25% to 50% by June 2017.
  • Increase FIT kits return rate from 55% to 70%.
  • Increase percent of eligible clinic patient who receive FIT kits at the end of clinic visits from 25% to 90%.

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Neighborhood Healthcare

Project Title: FIT SD: Neighborhood Healthcare
Program Director: James Schultz, MD, MBA, FAAFP, DiMM
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening, Cancer Health Care – Delivery, Screening Barriers, Health Communications
Relationship to Colorectal Cancer: Colorectal cancer, Average Risk Population Screening, CRC Diagnostics, Precancerous lesions

FIT-SD is a partnership between the San Diego County Medical Society Foundation (SDCMSF) (lead agency), Kaiser Permanente, and four community clinics in San Diego County: Neighborhood Healthcare, Operation Samahan, San Diego Family Care, and San Ysidro Health Center. 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.

This partnership has honed clinic in-reach at Neighborhood Healthcare to improve colorectal cancer screening rates at three community clinics. Neighborhood Healthcare will continue working to further improve the percentage rate of return and follow up for FIT testing; incorporating best practices from the American Cancer Society's guidelines. Melissa Barajas, RN, BSN, PHN is the lead and oversees program compliance.

Neighborhood Healthcare's colorectal cancer screening program is a roll out of the FIT-SD pilot program, and has been in place for three years. Prior to FIT-SD, the clinics' screening rate averaged 26.8%. As of November 2015, the clinics’ average screening rate was 58%.

The objectives for this cycle (April 1, 2016 – March 30, 2017) are:

  • By March 30, 2017, increase the screening rate by 10% at each of nine clinic sites
  • By March 30, 2017, increase the FIT kit return rate by 10% at each of nine clinic sites
  • By March 30, 2017, insure that 90% of eligible clinic patients receive kits at the end of a clinic visit

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White Memorial Medical Center

Project Title: FIT plus EWC Outreach in Los Angeles via Cecilia de La Hoya Cancer Center at WMMC
Program Director: Eva Meyers, PhD, FNP-BC, RN
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening
Relationship to Colorectal Cancer: Average Risk Population Screening

Project Overview
This proposal will be the fourth for the Cecilia G. de la Hoya Cancer Center (CdlHCC) at White Memorial Medical Center (WMMC) and will build on the now-established program of FIT outreach to uninsured, low-income populations in the East Los Angeles metropolitan area. We propose to continue the successful incorporation of FIT screening into the California Department of Healthcare Services 'Every Woman Counts' (EWC) program. The outreach events for EWC include community and church health fairs, as well as mobile screening services, such as mobile mammograms. Staff from WMMC attend the fairs to enroll women eligible for breast and cervical cancer screening, then include FIT kits for average risk women age 50 to 75. They extend FIT kits to eligible male friends and family members accompanying the women to the events, or education the women to take the kit home for eligible males who reside within their household, e.g. spouses/brothers. The staff provide detailed instructions to participants to ensure successful test completion. Participants are registered as patients with WMMC for accurate follow-up on test results and to provide colonoscopy services and, if needed, surgical services for those who have a positive FIT. WMMC will cover the cost of any required specialty services via charitable funds.

Specific Aims
  1. Increase rates for first-time colorectal cancer screening in average risk individuals of Hispanic and Korean descent in the East Los Angeles metropolitan area from 50% to 70%.
  2. Re-screen those individuals from prior years who are now due for their annual screening.
  3. Re-contact individuals given kits in prior years to encourage test completion and provide additional kits if needed.
  4. Methods
    The format of enrolling eligible women and their male family members for colorectal cancer screening at the same time as the women are being screened for breast and cervical cancer has been successful to date, with rates for completed tests averaging over 50%. We will continue this in Phase 4. Also, Phase 3 of this project allowed us to establish a presence in the hard-to-reach and rarely screened Korean population, which we would like to continue with Phase 4.

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    * Supported in part by a grant from .