- Mission Neighborhood Health Center
- Northeast Valley Health Corporation (NEVHC)
- Petaluma Health Center
- Shasta Community Health Center
- Vista Community Clinic
The 2024 C4 Community Grants were funded, in part, by a grant from the American Cancer Society.
Mission Neighborhood Health Center
Project Director: Jaime Ruiz, MD
Organization Headquarters: San Francisco, CA
Amount Funded: $10,000
Project Title: Increasing Colorectal Cancer Screenings
Priority Areas:
- Primary Prevention and Screening
- Expanding screening to 45-75yo
- Improving colonoscopy completion rates
- Timely workup of symptomatic patients
Recent research conducted by the University of Colorado School of Medicine has highlighted concerning trends in colon cancer diagnoses among young adults, particularly noting increased rates of new cases and advanced-stage diagnoses within specific demographic groups. Of particular concern are findings indicating elevated rates among non-Hispanic Black and Hispanic individuals.
In response to this critical health concern, the Mission Neighborhood Health Center (MNHC) is undertaking a proactive initiative to enhance colorectal cancer screening rates. The current screening rate of 52% in Nov 2023 will be diligently raised to 60% by April 2025, equating to the screening of an additional 150 patients.
MNHC’s strategy focuses on two primary objectives: increasing community awareness and augmenting screening delivery. To heighten community awareness, MNHC plans to distribute informative colorectal cancer screening infographics in all clinic exam rooms. Recognizing the diversity of the patient population, these materials will be translated into Spanish to ensure broader accessibility and understanding.
Simultaneously, MNHC aims to boost screening delivery efficiency by implementing a targeted intervention: mailing FIT (Fecal Immunochemical Test) kits to eligible patients due for screening and having upcoming appointments. These kits will include return envelopes and clear instructions for ease of use and return.
To facilitate these objectives, MNHC will conduct in-service trainings for clinic staff mainly our community health workers to ensure meticulous documentation of distributed and returned kits, track FIT kit results, and efficiently manage colonoscopy referrals. Moreover, outreach staff will undergo motivational interviewing training to effectively advocate for the significance of colorectal cancer screenings, encouraging patient participation and comprehension.
The project’s progress and activities will be meticulously tracked and managed through the utilization of Ochin EPIC, to monitor, evaluate, and optimize project initiatives, ensuring the efficient implementation of interventions and the attainment of set goals.
Northeast Valley Health Corporation (NEVHC)
Project Director: Jasmine Galindo, MPH, CHES
Organization Headquarters: San Fernando, CA
Amount Funded: $10,000
Project Title: Increasing Colorectal Cancer Screening (ICCS) Project
Priority Areas:
- Primary Prevention and Screening
- Expanding screening to 45-75yo
- Improving assessment of family cancer history
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 (C4) to help improve the health outcomes of our predominantly Latinx patients by improving the percentage of patients who return a completed fecal immunochemical test (FIT) kit.
More specifically, C4 funds will support staff training and supplies needed to increase the percentage of NEVHC’s 19,966 patients 45-75 years of age who complete a colorectal cancer screening from a baseline of 46% in November 2023 to 56% by February 2025. To do so, NEVHC will focus efforts on interventions that target both patients provided with in-person and virtual, i.e., telehealth and telephone, visits.
Our first objective is to increase the percentage of FIT kits distributed at Point of Care at NEVHC Health Centers. To do so, the NEVHC Quality Improvement (QI) team will conduct training sessions with lab staff as well as Women’s Health and Adult Medicine Medical Assistants at 14 NEVHC Health Centers that will emphasize the importance of timely colorectal cancer screening, proper completion of the FIT kit test and proper kit test documentation. We will also train these clinic staff members on our colorectal cancer screening workflow for virtual visits, which have increased significantly at NEVHC since COVID-19.
Our second objective is to increase the percentage of patients who return their FIT kits. In order to improve our return rate, we will implement a number of activities including 1) sending reminder text messages and letters to in-person or virtual patients who did not return their FIT kits after receiving them at Point of Care, 2) text messaging in-person and virtual patients who were due for a FIT kit at the time of their last completed visit and left the appointment without said kit (Missed Opportunities); and 3) calling each Missed patient who attends one of our two Health Centers with the highest Missed Opportunities rate.
Our third and final objective is to train NEVHC Adult Medicine Providers to assess family colorectal cancer history in order to identify high-risk patients prior to their screening.
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.
Petaluma Health Center
Project Director: Rachel M. Joseph, FNP, MPH
Organization Headquarters: Petaluma, CA
Amount Funded: $10,000
Project Title: Colorectal Screening Expansion and Assessment Improvement
Priority Areas:
- Primary Prevention and Screening
- Expanding screening to 45-75yo
- Improving assessment of family cancer history
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 eleven sites ‚ its main clinic and administrative offices, a homeless clinic, three school-based health centers, a vision center, a mobile medical van, Point Reyes Community Health Center, Bolinas Community Health Center and Rohnert Park Health Center (RPHC). In 2022, PHC served 39,508 unduplicated patients and provided 199,344 visits.
Despite PHC’s patient population and community having higher than average cancer rates, PHC’s colorectal cancer screening rates have steadily declined due to the backlog created during the COVID-19 pandemic combined with an influx in patient population. Colorectal cancer rate went from 54% in 2018 to 48% in 2022, with colorectal cancer rates further declining to 43% by 2023. Simultaneously, PHC saw an increase of approximately 40,000 new patients, primarily from low-income, uninsured, or underinsured backgrounds ‚ many of whom came from areas with some of the highest health disparities in Sonoma County.
Through this project, PHC proposes to reduce disparities in colorectal cancer screenings for adults ages 50-75, expand to the USPSTF recommendation of 45-75, and increase its colorectal cancer screening rate to 50 percent or greater for the target population. To reach this goal, PHC will directly address the barriers patients face in getting tested by: 1) Enhancing the Provider Reminder/Recall System: By leveraging PHC’s updated electronic health record system, EPIC, staff will improve the provider reminder/recall system, enabling healthcare providers to alleviate patient backlogs and establish more effective connections with new patients; 2) Reducing Structural Barriers via Enhanced Case Management. To overcome common structural barriers PHC will create reports on gaps in care for colorectal screening, using the information found to tailor their case management efforts to better fit the needs of the population. This includes crucial support such as transportation assistance, translation services, and streamlined scheduling. This improved model will be implemented at PHC’s two most frequented sites: Petaluma Health Center and Rohnert Park Health Center.
As an FQHC, PHC serves some of the most at-risk members of the community with slightly over 95% of PHC patients (95.22%) falling at or below 200 percent of the Federal Poverty Level (FPL), and 75% living at or below 100 percent of FPL. Notably, 19% of our patients remain uninsured, and 68% are enrolled in Medical. Currently, 20,497 (48.7%) of PHC’s patients identify as Latino/Hispanic. Fifty-eight percent of our Latino/Hispanic patients are women, 82.5% prefer to get communications in Spanish, 72% are enrolled in Medical and 21% are uninsured. This project will aim to reduce screening barriers through the use of evidence-based interventions and expand to communities in need.
Shasta Community Health Center
Project Director: Theresa Blanco
Organization Headquarters: Redding, CA
Amount Funded: $10,000
Project Title: Colorectal Cancer Prevention and Prevention
Priority Areas:
- Primary Prevention and Screening
- Expanding screening to 45-75yo
- Improving colonoscopy completion rates
Shasta Community Health Center’s proposed project aligns seamlessly with our mission of delivering high quality health care services to the community. The primary goal of this project is to effect a tangible increase in colorectal cancer screening rates within our target population, elevating it from the current 52.41% to an ambitious goal of 63% within a 12-month timeframe.
The first objective of the project is to elevate awareness and foster sustained internal engagement among our staff. This will be achieved through the launch of an internal campaign during Colorectal Cancer Awareness month, incorporating impactful elements such as banners, posters, and educational materials that underscore the critical importance of colorectal cancer screening. The aim is to enhance staff awareness and engagement by 20% over the ensuing 12 months.
The second pivotal objective involves the implementation of continuous quality improvement initiatives geared towards augmenting screening rates. To accomplish this, we plan to leverage clinical staff daily huddles and pre-visit planning to identify eligible patients and ensure the prompt distribution of FIT kits. Our strategy also encompasses intensifying FIT kit distribution rates and improving patient compliance.
To fulfill these objectives, FIT kits will be dispatched to eligible patients, accompanied by clear instructions available in nine different languages to cater to our diverse patient population. A multi-disciplinary team will be assembled to plan the colorectal cancer screening campaign. Activities of this team include defining goals, creating messaging to staff and patients, developing educational materials, providing education and training to staff, and developing a communication plan for performance. Additionally, posters and banners will be strategically placed across all our locations, serving the dual purpose of educating patients on the importance of colorectal cancer screening and reminding clinicians to initiate discussions with their patients regarding screening. Proactive patient outreach efforts will also be undertaken to further support and encourage participation. Outreach efforts and number of returned FIT kits will be tracked and the associated trends will be documented.
Vista Community Clinic
Project Director: Rajni Lopez, MPH
Organization Headquarters: Vista, CA
Amount Funded: $10,000
Project Title: Enhancing VCC’s Colorectal Cancer Screening Program
Priority Areas:
- Primary Prevention and Screening
Vista Community Clinic (VCC) is a major provider of primary health care services in Southern California, and expects to have served over 60,000 unduplicated patients in calendar year 2023.
While the effects of the pandemic have diminished somewhat at this point in time, those effects have included decreasing the number of patients who receive in-person services, creating challenges related to patient education, de-emphasis in the minds of some patients regarding the importance of preventive care/screenings, and a general atmosphere of anxiety among clinical staff that has persisted to some extent, as staff receive notices on a nearly daily basis at this time regarding colleagues who have contracted COVID.
VCC continues to work to increase the number of CRCS tests that are completed and returned. A few of these challenges remain: a significant number of patients are not completing and returning the test or the data fields correctly to ensure that the test will be accepted and processed. One key to increasing and sustaining high rates of CRCS completion is staff education and motivation. To that end, through this proposal VCC will expand the range of staff who receive training related to CRCS, with an expectation that more broadly generalizing this information and these practices among staff will translate to larger numbers of patients who both complete and return CRCS, and do so correctly.
VCC will use requested C4 funds to engage in a thorough campaign of staff education regarding all aspects of CRCS, including training staff to educate patients regarding all CRCS aspects, such as who should be testing, the purpose and importance of testing, how to use and complete the test kit, how to complete all test data fields correctly, how to return the test, and how best to receive additional information and support if patients have any questions and/or trepidation in the context of testing. This education will be provided to staff at eight clinic sites, and will include specific guidance to improve distribution and return of CRCS tests among patients who are seen via telehealth. Staff who have not received this education/training in prior years, including Wellness Advocates and Enhanced Care Managers and Chronic Care Managers, will be included in those receiving it this time.
In addition, as VCC is moving to add the Cologuard test to its palette of CRCS tools. Relevant staff will be trained with regard to the benefits of this test and the protocol for its use, which will allow VCC to significantly expand use of this test in the coming year. The project’s overarching goal is to increase the number of CRCS tests that are distributed, correctly completed and labeled, and returned for processing. Following from that, the project will ensure that all those patients receiving a positive result receive assistance in completing a diagnostic colonoscopy.
