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2017 Community Grants funded by C4

For 2017, the C4 Board of Directors released a Request for Proposals that was distributed throughout California. The Board agreed to distribute $91,950 for grants that met the competitive review criteria. Of the twenty 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 2017 can be accessed through the individual links below:
  1. Altura Centers for Health – Tulare, CA

  2. Champions for Health – San Diego, CA

  3. Chinese Community Health Resource Center – San Francisco, CA

  4. Clinica Sierra Vista – Fresno, CA

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

  6. Lifelong Medical – Berkeley, CA

  7. Los Angeles American Indian Health Project – Los Angeles, CA

  8. Northeast Valley Health Corporation – Sylmar, CA

  9. Redwoods Rural Health Center – Redway, CA

  10. Vista Community Clinic – Vista, CA

Altura Centers for Health

Project Title: C4 FIT project
Project Director: Victor Sunga, M.D.
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening
Relationship to Colorectal Cancer: Average Risk Population Screening

Altura Centers for Health (ALTURA) is a 501(c)(3) non-profit Federally Qualified Health Center which serves the low income population in the San Joaquin Valley in Central California. ALTURA has eight clinical sites, and is the largest provider of primary health and dental care to the underserved in the city of Tulare and surrounding rural communities. ALTURA has seven clinical sites in the city of Tulare, and one in Woodville. In the calendar year 2015, ALTURA provided medical, dental and behavioral health care to 27,020 patients. Seventy-five percent (75%) of patients are Hispanic, and 17% are Migrant and Seasonal Farm Workers. ALTURA provides free door to door transportation for patients via minivan shuttle.

The goal of this C4 FIT project is to increase colorectal cancer screening rates from 42% (2015 UDS data) to 50% by the end of the project period. Altura will utilize the “2016 Hispanics/Latinos and Colorectal Cancer Companion Guide” to promote colorectal cancer screening in a culturally appropriate manner, among the primarily Hispanic patient population. Grant funding will allow Altura Centers for Health to increase capacity for colorectal cancer screening by hiring a Patient Care Coordinator to oversee a postcard recall/reminder system, identify patients needing the screening during daily appointments (as identified in the Morning Huddle report generated by the NextGen electronic health record system), distribute a FIT kit during annual exams, educate patients on the importance of the screening, and track the patient’s lab results for reporting and referrals. During flu season, ALTURA will implement the Fit Flu program. Progress towards meeting the clinic-wide colorectal cancer screening rate will be discussed at Quality Assurance-Quality Improvement Meetings to monitor trends and quality performance.

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Champions for Health

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

FIT-SD will continue to coordinate vital efforts throughout San Diego County to increase colorectal cancer screenings among low-income adults at federally qualified health centers (FQHC), and improve access to diagnostics and subsequent treatment. Our focus will continue to be on high-risk populations, particularly adults in the Latino communities, where current screening rates are problematically low.

FIT-SD will focus not only on specific patient care, but on assisting the community clinics to improve their overall screening rates by convening clinics annually to discuss best practices, providing in-service training to providers and healthcare workers, and expanding the network of gastroenterology physicians and endoscopy facilities willing to provide diagnostic services to uninsured adults requiring such care.

During this program year, our objectives are to: (1) provide a minimum of 9 community clinic partners with in-service training, education and support to increase CRC screening rates (2) secure a minimum of 20 CRC champions to attend annual CRC roundtables and share best practices (3) provide intensive case management, navigation and pro bono treatment to a minimum of 50 low-income, uninsured San Diego County adults requiring colorectal cancer diagnostics and (4) secure two new facilities for pro bono endoscopy.

The FIT-SD collaborative expands on a seven 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.

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Chinese Community Health Resource Center

Project Title: Interactive Website to Educate Asians on CRC Screenings
Project Director: Angela Sun, PhD, MPH
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Screening Barriers & Health Communications
Relationship to Colorectal Cancer: Colorectal cancer, Average Risk Population Screening & High Risk Screening

Colorectal cancer (CRC) is the second most common cancer among Chinese and the fourth most common cancer among Vietnamese Americans. Asians are less likely than non-Hispanic whites to be screened for colorectal cancer. CRC screening is a proven way to prevent colorectal cancer by finding polyps or early CRC. The proposed project aims to create an interactive website in the Chinese (traditional and simplified Chinese for written materials, Cantonese for the videos) and Vietnamese languages to address CRC and its prevention among Chinese and Vietnamese Americans. These features will be available on a site frequently visited by providers as well as the lay public. The proposed features are:

  1. Responsive Video Segments - This feature will allow users to select from a list of questions on CRC screening commonly identified among Asian Americans. Once the user makes a selection, the selected question will link the user to view a segment of the video which addresses the question. This feature will tailor to users’ specific concerns/barriers about CRC screening and present information relevant to their concerns.

  2. Q & A Feature - The Q&A component will provide a safe setting for users to ask personal questions and specific logistical questions related to CRC, such as screening preparation, procedure, post-procedure, and etc. The questions will be addressed by appointed senior health educators from the project team. This interaction serves to empower user to make informed decisions regarding CRC screening.

  3. Action Button/Icon - This feature will motivate users to take action by enabling them to make an appointment for CRC screening. When users click on the Action Button, it will be linked to contact numbers for screening appointments within participating health systems.

  4. Automated Reminder Feature - There will be a “Plan to make appointment” button for users who are not yet ready to make an appointment immediately after viewing the information about CRC. Once users click on the “Plan to make appointment” button, it will activate an automated weekly reminder in the form of email or text message with a “Yes or No” feature to allow users to report the status of their CRC screening appointment. If the user reported “Yes,” no further reminders will be sent. A maximum of three reminders will be sent to each user.

  5. User’s Progress Bar – This bar will display users’ progress for making a CRC screening appointment and motivate users to complete their CRC screening.

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Clinica Sierra Vista

Project Title: Get FIT
Project Director: Sunday Irene, MD
Total Gran Amount Funded: $7,200
Priority Area: Primary Prevention and Screening; Screening Barriers; Health Communications
Relationship to Colorectal Cancer: Colorectal Cancer; High Risk Screening

It is the goal of Get FIT to increase awareness of colorectal cancer and the necessity of colorectal cancer screening as part of primary prevention and detection in primary care. To this end we improve our internal access to FIT kits, educate providers, patients, and the community, and improve our internal colorectal cancer policies and systems integration to increase the rate of screening compliance.

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Family Health Centers of San Diego

Project Title: Increasing CRC Screening Rates using Patient Navigation
Project Director: Gracie Duran, BA
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening
Relationship to Colorectal Cancer: Average and High Risk Screening Enhancement

In an effort to decrease mortality related to colorectal cancer (CRC), Family Health Centers of San Diego (FHCSD) proposes to increase CRC screening rates by 17% at the Chula Vista Family Health Center (CVFHC) from a baseline of 51.31% to 60% by March 31, 2018. A secondary goal of the project is to increase access to care for underserved patients with an abnormal FIT by: (a) increasing the proportion of patients with abnormal screening tests who receive complete diagnostic evaluation; and (b) by decreasing the time from identification of the abnormality to diagnostic resolution of the abnormality.

The CVFHC, one of 23 clinics in FHCSD’s healthcare system, cares primarily for low-income (96% of patients live at or below 200% of the Federal Poverty Level), ethnically-diverse patients (73% Hispanic, 7% white [excluding Hispanic], 5% African American, 8% Asian/Pacific Islander, 7% more than one race). Patients face formidable barriers to completing CRC screening such as limited English proficiency, lack of insurance/prohibitive costs, fear of the process, and lack of knowledge of disease risk and the benefits of screening.

Over the past year, the clinic has been implementing a number of quality improvement efforts to increase CRC screening rates, with the broader aim of achieving 80% screened by 2018. This project will add a 0.20 FTE Patient Navigator (PN) to these ongoing efforts. The project will target active patients who are already visiting the clinic, to ensure that they receive culturally and linguistically competent education and instruction about screening, and leave the clinic with a FIT kit in-hand. The PN will provide intensive follow-up for patients who have incomplete screens or who are considered high risk and need referral for colonoscopy. The PN also will provide critically needed assistance to patients with an abnormal screen.

The project will leverage the work of a National Cancer Institute 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 underserved, diverse, low-resource patients. In addition, the project will leverage lessons from a C4 grant currently being implemented at FHCSD’s Chase Avenue Family Health Center.

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Lifelong Medical

Project Title: Reducing Barriers to Colorectal Cancer Screening: Safety Net Services for Low-Income Adults
Project Director: Nermeen Iskander
Total Gran Amount Funded: $8,000
Priority Area: Screening Barriers
Relationship to Colorectal Cancer: Colorectal Cancer Screening

LifeLong Medical Care (LifeLong) is a Federally Qualified Health Center (FQHC) that serves more than 50,000 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.

LifeLong will improve colorectal cancer screening rates by engaging care teams in developing and implementing process improvement projects. Selected care teams will track, test and refine process improvements to increase Colorectal Cancer Screening rates. Data will be evaluated to identify workflows and process improvements with the greatest impact, and plans will be developed to share and spread these approaches across LifeLong health centers.

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Los Angeles American Indian Health Project

Project Title: UAII CRC- PHASE Project
Project Director: Serena C. Marquez, MPH, BA
Total Gran Amount Funded: $6,750
Priority Area: Primary Prevention and Screening; Screening Barriers; Health Communications
Relationship to Colorectal Cancer: Average Risk Population Screening

Background: United American Indian Involvement, Inc. (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 sought to target a minimum of 150 clients (20%) of the entire target population (743 registered AI/AN clients between the age range of 50-75 years) to provide education and screening for colorectal cancer. As of November 28, 2016, UAII has succeeded at screening 108 clients. UAII has currently reached 72% of the goal (108 clients screened for colorectal cancer out of the target 150 clients) for the 2016 grant period.

For the year 2017 grant period, UAII will seek to target 175 clients (27%) of the entire AI/AN target population (647 registered AI/AN clients between the age range of 50-75 years) to provide education and colorectal cancer screening.

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 continue to 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 continue to 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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Northeast Valley Health Corporation

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

Northeast Valley Health Corporation (NEVHC), a non-profit, Joint Commission Accredited Federally Qualified Health Center (FQHC) serving medically underserved residents of Los Angeles County’s San Fernando and Santa Clarita Valley, respectfully requests $10,000 from the California Colorectal Cancer Coalition to help improve health outcomes among our predominantly Latino patients by improving the percentage of patients that return a completed FIT Kit. More specifically, your funds will support the staff and supplies needed to increase the percentage of NEVHC’s 9,283 patients 50-75 years of age that complete colorectal cancer screening from a baseline of 37.8% in October 2016 to 48.3% by February 2018. 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 clinical staff at eight NEVHC health centers. Trainings will emphasize the importance of timely colorectal cancer screening and the procedures for test kit distribution as well as review Fit Kit Distribution “missed opportunities” data per health center.

Our second objective is to increase the percentage of patients who return their FIT Kits. In order to improve our FIT Kit return rate, we will utilize Volunteer Student Interns to send patients who have not returned their Kits reminders letters and to conduct phone calls. 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, will be used to help conduct and track program activities.

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Redwoods Rural Health Center

Project Title: Redwoods Rural Health Center (RRHC) Colorectal Cancer Screening Program
Project Director: Tina Tvedt, MPA, CMPE
Total Gran Amount Funded: $10,000
Priority Area: Primary Prevention and Screening; Health Communications
Relationship to Colorectal Cancer: Average Risk Population Screening; Underserved, Uninsured, and Underinsured Populations

Long-term Objectives and Specific Aims:

  • RRHC strives to create standardized protocols and workflows to ensure all of the target patients, age 50 to 75 years, are screened for colorectal cancer in accordance with the CDC guidelines.

  • If a patient has a positive FIT/FOBT test, RRHC’s referral coordinators will connect the patient with specialty care for diagnosis and timely treatment.

  • All medical assistants and medical providers will be trained on policies, protocols and evidence-based practices to improve colorectal cancer screening rates.

  • RRHC’s goal is to increase the number of patients screened for colon cancer by 67% during the 12-month project. RRHC’s progress towards meeting this goal will be measured on a quarterly basis.

  • The long term goal of primary prevention and screening is to detect and diagnose colorectal cancer at early stages when it is treatable.

Description of Methods to Achieve Goals:
In order to achieve the aforementioned objectives, RRHC will implement a multi-prong strategy:

  • Provide staff training on the standing order for colon cancer screening, as well as the colon cancer screening processes.

  • Utilize in-house Immunochemical Fecal Occult Blood Tests as well as mail-in FIT tests with instructions and educational guides for patients

  • Develop i2i Tracks reports which detail colon cancer screening rates by provider, as well as, order status of FOBT/FIT tests provided by RRHC.

  • Conduct health communications including public service announcements (PSAs), mailers/text messages, as well as individual follow-up calls to patients who haven’t submitted their FOBT/FIT tests.

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Vista Community Clinic

Project Title: Supporting enhanced FIT test distribution & test compliance
Project 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 Population Screening

Vista Community Clinic’s 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; the lack of an electronic prompt to remind the care team to promote CRC screening test use; and, until fairly recently, the use of the FOBT, which is a more onerous test than the FIT.

In the last 1-2 years, VCC has made significant improvements in this regard. Where two years ago the colorectal cancer screening rate was just above 10%, the rate improved to nearly 26% in September 2015, and at the time of this submission stands at 39.6% for 2016. While these gains are significant and meaningful, VCC understands the importance of promoting universal screening among the target population, and believes that there are additional steps that can be taken to improve both distribution of FIT tests, and completion and return of those tests.

VCC believes the current improvement in screening rates to be a function of turning to use of the FIT test; improving patient education around both the purpose of the test and its proper use; improved test labeling; improved staff training, and the unbundling of tests to ensure that the CRC screening process is completed; assignment of a Provider Champion at each clinic site to ensure proper application of new protocols and to motivate staff; and the use of a new care guidelines program within the EHR that identifies patients in the target screening population and their related status.

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