For 2020, the C4 Board of Directors released a Request for Proposals that was distributed throughout California. The Board agreed to distribute $95,000 for grants that met the competitive review criteria. 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 2020 can be accessed through the individual links below:
- Asian Health Services
- Neighborhood Healthcare
- Northeast Valley Health Corporation
- Parktree Community Health Center
- Petaluma Health Center, Inc.
- Salud Para La Gente
- San Diego County Medical Society Foudnation
- Tiburcio Vasquez Health Center, Inc.
- Vietnamese American Cancer Foundation
- Vista Community Clinic
Asian Health Services
Project Title: Increasing Colorectal Cancer Screenings among APIs
Project Director: Agnita Pal, M.Eng., B.A.Sc.
Total Grant Amount Funded: $10,000
Colorectal cancer (CRC) is the second leading cause of cancer mortality in the United States. Despite the availability of different CRC screening methods, including the fecal immunochemical (FIT) test, CRC screenings have been consistently underutilized by ethnic minorities–including Asian and Pacific Islanders (APIs). California ethnic-specific data showed that CRC ranked among the top three cancers for APIs (California Institute of Health, 2019). In Alameda County, Asians had a lower screening rate (62.3% compared to the overall population (71.3%). For Asian Health Services’ (AHS) target population, vulnerable APIs face adverse social determinants of health including poverty, LEP, and low levels of education. These difficult circumstances create further barriers to achieving optimal CRC screening rates.
To address the poor CRC screening rates among APIs in Alameda County, AHS proposes the “Increasing Colorectal Cancer Screenings among APIs” project to: (1) increase access to CRC screenings; (2) increase demand for CRC screenings; and (3) build out a more robust system of tracking the continuum of care. AHS will increase access to CRC screenings by identifying and targeting at least 700 unique patients at risk for CRC, and distributing FIT kits to them through traditional mail. AHS will also translate CRC health information into multiple Asian languages to ensure limited English-proficient (LEP) patients at higher risk for CRC receive the necessary culturally and linguistically appropriate health information. AHS will provide culturally and linguistically appropriate CRC health information and education to the more than 3,500 annual patients and community members who have been previously identified as at-risk for CRC. Lastly, AHS will increase community demand for CRC screenings by highlighting the importance of CRC screenings at its Patient Leadership Council (PLC) member meetings. PLC members are composed of empowered patient advocates who are trained in relevant health topics impacting their respective communities. Through the proposed program, AHS hopes to reduce the prevalence of CRC through targeted screenings, and improving the quality of care for those who receive abnormal CRC test results.
Neighborhood Healthcare
Project Title: Increasing FIT Return Rates
Project Director: Michelle Hughes, PharmD
Total Grant Amount Funded: $10,000
Neighborhood Healthcare’s Increasing FIT Return Rates project will increase the number of patients who receive this critical test. The goal is to achieve and sustain an organization wide FIT return rate of 75% which is currently at 68%. In addition, we aim to increase the CRC screening rate by 10% from a baseline of 57%. A recent needs assessment conducted by Director of Quality and Population Health found several areas for improvement: transportation is a barrier to having patients return the FIT kit; Medical Assistant staffing with frequent turnover needs consistent and standardized training and messaging to patients; site leadership does not consistently hold staff accountable for rates; there is a need to establish and dedicate staff for outreach efforts; and there is a need to maximize opportunities to provide recommended screening, such as lab only visits. By addressing these needs we aim to improve FIT return rates and overall CRC screening rates.
Patients identified with having transportation barriers will be supplied pre-stamped envelopes to return FIT kits. All Medical Assistants (MA) will be trained on proper FIT kit instructions including notifying patients to return as soon as possible with next bowel movement. The Director of Quality and Population Health will establish an outreach protocol and identify key staff to conduct outreach for patients not actively coming in for preventative care. A ‘Lab/FIT’ protocol will also be developed for FITs to be ordered by lab staff. Local leadership (Site Manager, Clinical Service Supervisor and Clinical Team Leader) will hold their teams accountable for their FIT return rate and overall CRC screening rates. This is supported by a quality incentive program for support staff.
Northeast Valley Health Corporation (NEVHC)
Project Title: Increasing Colorectal Cancer Screening (ICCSR)
Project Director: Debra L. Rosen, RN, MPH
Total Grant Amount Funded: $10,000
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 who return a completed fecal immunochemical test (FIT) kit.
Specifically, your funds will support staff training and supplies needed to increase the percentage of NEVHC’s 12,310 patients 50-75 years of age that complete colorectal cancer screening from a baseline of 56.2% in October 2019 to 62.0% by February 2021. 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 who return FIT Kits through patient recall interventions that include texting, mailing letters and live phone calls.
Our first objective is to increase the percentage of FIT kits distributed at Point of Care at NEVHC health centers. In order to do so, the NEVHC Quality Improvement (QI) team will conduct training sessions with lab staff and medical assistants at nine 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 health center FIT kit distributions.
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 send reminder text messages to patients who have yet to return them. Moreover, our QI Volunteer Student Interns will send reminder letters as well as make phone calls to patients who have yet to return their FIT kits. The reminder text messages, letters and phone calls will enable our QI Department to provide patients with additional colorectal cancer screening education as well as allow patients to 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.
Parktree Community Health Center
Project Title: Increasing Colorectal Cancer Screening Rates at PCHC
Project Director: Giselle Diaz, MPH
Total Grant Amount Funded: $10,000
Parktree Community Health Center was founded in 1995, incorporated in 2005, became a 501(c)(3) in 2007, and became a Federally Qualified Health Center in 2014 with two health centers. Over time, PCHC expanded its services from primary care to include: behavioral and oral health, podiatry and optometry. PCHC is a Level 2 Patient Centered Medical Home. To best serve the community, PCHC now has five clinical locations serving patients in Pomona, Ontario, and the surrounding areas. In 2018, PCHC served 10,343 individuals. This number has been surpassed in 2019, with 12,336 individuals served through November 2019.
Parktree Community Health Center proposes increasing colorectal cancer screening rates from 29% in October 2019 to 40% by February 2021. To achieve a screening rate of 40%, Parktree will need to screen an additional 301 patients during the grant period, this is approximately a 37.9% increase. Parktree will reach the goal of increasing screening rates to 40% of the eligible population by implementing interventions with a focus on 1.) increased community demand, 2.) increased community access, and 3.) increased provider delivery.
Community demand will increase by placing colorectal cancer screening infographics in exam rooms across all clinics to prompt the eligible population to inquire about being screened. Community demand will also increase by sending text messages to patients who have received a FIT kit and have not returned it, offering guidance on how to complete a FIT kit with the option to reply “Y” for more information. Patients who reply “Y” will be contacted and engaged by QI assistant. Community access will increase by reducing administrative barriers through mailing FIT kits to patients who are due and have an upcoming appointment. Return envelopes and language appropriate instructions will also be provided as needed. Provider delivery will increase through provider reminders. Provider reminders will be in the form of implementing the regular use of i2i visit summary sheets as standard practice in family medicine. Provider reminders will also be in the form of sharing various colorectal cancer screening reports with providers and their care teams on a monthly basis. The reports will include: monthly screening rates, missed opportunities rates, and FIT kit return rates. Lastly, clinic staff will receive in-service trainings to provide refreshers on the importance of colorectal cancer screenings, reviewing patient education when providing patients with kits, and a review on documentation of kits given, kits returned, FIT kit results, and colonoscopy referrals.
Petaluma Health Center, Inc.
Project Title: C4 Colorectal Cancer Screening Project
Project Director: Tiffany Jimenez, RN, MSN
Total Grant Amount Funded: $10,000
Petaluma Health Center (PHC) was founded in 1999 as a 501 (c) (3) public benefit corporation in response to the unmet healthcare needs of the residents of Sonoma County, California. In 2001, PHC became a Federally Qualified Health Center (FQHC). PHC has seven sites – its main clinic and administrative offices, a homeless clinic, three school-based health centers, a vision center, and Rohnert Park Health Center (RPHC). In 2018, PHC served 33,577 unduplicated patients and provided 181,905 visits. Our mission is to ensure that all residents of Sonoma County have access to high quality, prevention-focused, patient-centered health care services.
Through this project, PHC proposes to reduce disparities in colorectal cancer screenings for adults ages 50-75 and increase its colorectal cancer screening rate to 60 percent of the target population, which is approximately an additional 550 patients annually. To reach this goal, PHC will directly address the barriers patients face in getting tested by 1) increasing the number of Insure Kits mailed to patients monthly; 2) amplify marketing efforts aimed at educating the community and patients about colorectal cancer; 3) identify gaps in care to improve our colorectal cancer case management; and 4) research and implement new interventions to decrease screening barriers faced by our health center’s vulnerable populations.
The C4 colorectal cancer project will enable PHC to implement strategies and processes to combat the lack of education, recommendations, and overall access to colorectal cancer screenings.
Salud Para La Gente
Project Title: Improving CRC Screening Rates for Vulnerable Patients
Project Director: Danielle Obinger, BA, RN
Total Grant Amount Funded: $10,000
Salud Para La Gente’s (Salud) long-term goal is to build on its previous work of improving colorectal cancer (CRC) screening by increasing its screening rates for patients aged 50 to 75 from 47% to 55% by December 30, 2020. Salud has improved its CRC screening rate from 12% in December 2016 to 47% as of November 2019 – a 35% increase. In the past two years, Salud established care team pods within Family Practice who are screening, on average, 56.2% of their care team patients. However, because Salud also provides critical urgent care and same-day services and because of the transient and migrant nature of its patient population, patients who have not yet established primary care (and do not claim primary care services elsewhere) or are only using our OBGYN services without any additional primary care are being screened at rates as low as 11%.
Salud specifically aims to support these non-established and OBGYN-only patients to ensure access to preventive care and specifically to CRC screening. To achieve our CRC screening goal, we aim to screen at least 55% of this patient population (500 patients), which would bring our overall screening rates up to 56.8%. We plan to do this via the following methods:
Population Health Analyst will run monthly reports using Salud’s electronic health record and data analytics program to identify patients who have not yet completed CRC screening, and separate out empaneled and non-established/OBGYN-only patients who will be tracked by Family Practice Care Coordinator (CC).
CC will use FIT standing order to order FIT kit and use a telephone script (see Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers) to call patient and let patient know why screening is important, and that the order is ready to be completed.
If patient does not already have a physical exam scheduled to establish care with a primary care provider (PCP), CC will schedule physical exam.
Two weeks after the phone call, CC will send text message reminder (in either Spanish or English) to remind patients to complete FIT kit.
CC will send up to two text message reminders, separated out in two-week intervals, and if FIT kit has not yet been returned, then CC will call patient again to provide patient education on importance of CRC screening.
If FIT positive and patient has not yet established primary care, CC will forward result to Medical Director who will order colonoscopy referral (including via Access to Care county program for uninsured patients); if FIT positive and patient has established primary care, CC will forward result to new PCP.
CC will navigate patients with positive FIT result to their colonoscopy, including transportation assistance when needed.
Per the clinic’s usual workflow, Referrals Department will follow up open colonoscopy referrals with the specialty office at 30, 90 and 180 days to ensure that the colonoscopy was completed and that the ordering provider has received the results.
San Diego County Medical Society Foundation, dba Champions for Health
Project Title: FIT-San Diego
Project Director: Celene Salazar, RN
Total Grant Amount Funded: $10,000
The FIT-SD collaborative expands on an eight-year community partnership between which has facilitated more than 440 pro bono diagnostic colonoscopies and flexible sigmoidoscopies since 2008. Through these collective efforts, positive community screenings for the uninsured at federally qualified community clinics and free clinics in San Diego have a system of care ready to act to decrease mortality and illness related to colorectal cancer. Colorectal cancer is able to be detectable and treatable. When polyps and lesions occur, it is paramount that they be identified and removed or addressed immediately by a specialist, thus preventing the development of cancer in the future, and ensuring that those most at risk for colorectal cancer but are uninsured have the same level of dignity and follow-up as their insured counterparts.
FIT-SD is a vital collaborative effort throughout San Diego County to increase colorectal cancer screenings among low-income uninsured adults at federally qualified health centers (FQHC), improve access to life-saving diagnostics and subsequent treatment, and support system navigation of care outside of the primary medical home. Champions for Health focuses on high-risk populations, particularly monolingual and uninsured Latino adults, or other non-English speaking immigrants whose screening rates are historically and disproportionately low due to lack of access, and the high cost of diagnostics and treatment.
FIT-SD reduces cultural and structural barriers to access for patients, and supports FQHC and free clinic efforts to improve their overall screening rates by convening clinics annually to discuss best practices, providing in-service training to providers and healthcare workers, partnering with clinics to implement community-level screening events that widen access to multiple services, and expanding the network of gastroenterology physicians and endoscopy facilities willing to provide pro-bono diagnostic services to uninsured adults requiring such care.
During this program year, our objectives are:
By February 28, 2021, FIT-SD will increase capacity for pro bono diagnostic colonoscopies for uninsured patients with recruitment/retention of minimum 10 endoscopy centers and 10 GI specialists willing to provide pro bono services.
By February 28, 2021, FIT- SD will ensure a minimum of 40 low-income, uninsured adults receive needed diagnostic colonoscopies, and follow-up treatment with intensive case management.
By February 28, 2021, FIT-SD will facilitate increased screening rates at community clinics through clinic staff education and screening support for uninsured populations throughout the grant period by partnering with clinics to implement 4 community-centered FIT screenings throughout San Diego County.
Tiburcio Vasquez Health Center, Inc.
Project Title: Colorectal Cancer Screening Project
Project Director: Jessica Jamison, MPH
Total Grant Amount Funded: $10,000
The aim of the project is to increase the percentage and number of Tiburcio Vasquez Health Center’s patients screened for colorectal cancer.
The long term objective of the continuing Colorectal Cancer Screening Project is to improve rates of early colorectal screening by February 28, 2021 through the following activities and objectives: 1) Increase staff knowledge regarding Colorectal Cancer Screenings, Mail FIT, and FluFIT; 2) increase TVHC patient FIT compliance rate from 41% to 51% ; and 3) Refer 100% of patients with a positive or abnormal FIT for dx colonoscopy.
The project will serve TVHC’s patients who are at average risk of developing cancer; increasing the number of patients 50-75 years old who are given and who complete FIT kits, and to improve TVHC’s colorectal screening rates.
To accomplish these goals and objectives, TVHC will hold quarterly in-service trainings developed with our partners at the American Cancer Society. The project is a continuation of an existing project funded by C4. It replicates Kaiser Permanente Northern CA’s model with mailed FIT kits supported by patient outreach. Accordingly, TVHC will conduct patient outreach through the following steps in order:
- Using TVHC’s electronic health system, identify patients who need screening
- Send identified patients a personalized letter from their Primary Care Provider (a best practice)
- Two weeks later, TVHC mails each identified patient the FIT kit
- Text reminder sent (bilingual) and/or
- Reminder postcard sent (bilingual)
- TVHC staff telephones patients to remind and educate on the importance of FIT screening and encourages return
- Once completed FIT test is received, TVHC staff mails patient incentive gift card (while supplies last)
- TVHC staff provides referrals and navigation services to patients who have received a positive FIT, including transportation assistance when needed
The project’s objectives are also supported by Flu FIT at appointments, and at TVHC’s quarterly mammogram events.
Vietnamese American Cancer Foundation (VACF)
Project Title: Colorectal Cancer Initiative
Project Director: Becky Nguyen, MPA, MPH
Total Grant Amount Funded: $5,000
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. VACF was founded 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. Over the years, VACF has grown to be an integral and reputable organization that provides cancer care coordination and patient navigation along with health education and cancer prevention for the community.
Along the lines of VACF’s mission and that of the California Colorectal Cancer Coalition (C4), VACF is proposing the Colorectal Cancer Initiative to increase colorectal cancer awareness, education, and screening compliance for the underserved and underinsured Vietnamese American population based in Southern California. As the third leading cause of cancer death in this community, VACF’s Colorectal Cancer Initiative aims to mitigate the cultural, financial, and social barriers that Vietnamese Americans encounter when receiving efficient cancer education, care coordination, and psychosocial support, especially in a community with higher incidences of colorectal cancer at ages below the recommended screening population. The goal of the initiative is to destigmatize colorectal cancer in the community through education, empower community members to take ownership over their health care decisions, and promote regular screenings.
The initiative proposes to disseminate bilingual materials on the colorectal continuum of care to community members at health fairs and community events, provide culturally and linguistically tailored community seminars, educate the community about FIT kit use and distribute them with a 80% return rate, educate the masses on colorectal health through VACF’s physical and virtual communication channels, and provide patient navigation and individualized follow-up to clients with both normal and abnormal results. VACF’s dedicated staff will support patients every step of the way, linking individuals who are uninsured or underinsured to clinics that offer free colonoscopies and providing additional education for individuals with further questions and concerns.
Vista Community Clinic
Project Title: Improving Diagnostic Colonoscopy Follow-through
Project Director: Nannette Stamm, MPH
Total Grant Amount Funded: $10,000
The aim of this project, Improving Diagnostic Colonoscopy Follow-through, is to field a dedicated Colorectal Cancer Screening Patient Navigator (CRCS-PN), a portion of whose time will be funded through this award, and which will be dedicated to working with Vista Community Clinic (VCC) patients with a positive FIT test to ensure that those patients are scheduled for and complete a diagnostic colonoscopy in a timely manner (within 60 days of a positive FIT result).
The impetus for this project, and this proposal, is the fact that some VCC patients with a positive FIT test currently are not completing a diagnostic colonoscopy in a timely manner, and thus are putting themselves at greater risk for poor outcomes if a cancer ultimately is found. VCC estimates that the current time between a positive FIT and the completion of a diagnostic colonoscopy is 60 to 120 days. And in addition to that time lag, VCC acknowledges that currently it is providing for insufficient follow-up with those patients once they have completed their colonoscopy.
The objectives structuring this project include: provision of patient navigation services to all VCC patients with a positive FIT/FoBT test during the project period; an expectation that a minimum of 75% of patients with a positive FIT/FoBT will receive a referral for a diagnostic colonoscopy; an expectation that 70% of all VCC patients requiring a diagnostic colonoscopy based on a positive FIT will complete that within 60 days of receipt of FIT test results; and provision of follow-up services to every patient completing a diagnostic colonoscopy within 10 days of provider’s receipt of results.
VCC anticipates that the piloting of the CRCS-PN position will prove a key resource in achieving substantial improvements in FIT test, screening colonoscopy, and diagnostic colonoscopy rates, in addition to improving the quality of related care receiving along the whole of the screening/diagnostic/treatment spectrum related to colorectal cancer.
