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Principal Investigator: AIMEE S JAMES
Organization: WASHINGTON UNIVERSITY
Fiscal Year: 2024
Award: $461,980
Funding agency: National Cancer Institute
PROJECT SUMMARY/ABSTRACT
Many rural communities are medically underserved and experience persistently elevated rates of colorectal
cancer (CRC) incidence and mortality relative to declining national rates. Routine screening reduces population
CRC mortality, yet its impact is reduced because many adults who have an abnormal screening result with
fecal testing do not receive diagnostic follow-up with colonoscopy. Rural residents and healthcare providers
face unique barriers to screening follow-up including fewer providers who offer colonoscopy and longer travel
distances to obtain healthcare. Rural Southern Illinois is a region with high poverty, slow economic growth,
isolated households, widely dispersed medical care, and high CRC mortality. To reduce disparities in CRC
mortality in rural areas where fecal immunochemical testing (FIT) is a common first-line screening strategy, we
must identify effective, sustainable, and disseminable strategies to improve follow-up of positive screening
tests. Researchers at Washington University School of Medicine have collaborated with Southern Illinois
Healthcare, a rural not-for-profit health system, since 2015 to identify cancer prevention and control priorities
and reduce disparities. From 2017 to 2018, we conducted a formal pre-implementation assessment of CRC
screening and follow-up processes to identify feasible and promising evidence-based interventions and
strategies for improvement. Based on our substantial and specific preliminary data, we propose the following
Aims: Aim 1. Implement a multilevel intervention of follow-up of abnormal colon cancer screening tests
in primary care clinics across rural Southern Illinois. Using a stepped wedge trial design and cluster
randomization, we will implement the multi-level intervention in 18 clinics. We will intervene at three levels
(patients, providers/clinical teams, clinics) and evaluate implementation outcomes per Proctor's evaluation
model using interviews, surveys, and field notes. Aim 2. Evaluate the impact of the multilevel intervention
on follow-up of abnormal screening test results in rural primary care settings in Southern Illinois. Our
stepped-wedge design will allow us to test the impact of the multi-level intervention on rates of screening
follow-up. We measure outcomes at three levels. Patient: After positive FIT, receipt of referral and completion
of colonoscopy. Primary Care Provider: Receipt of positive FIT results and referral for follow-up. Clinic-level:
Patients with positive FIT complete colonoscopy. We will assess change in CRC screening rates and
investigate interactions between and across levels. Data for primary outcomes will come from the healthcare
system's ongoing patient registry that draws from electronic medical records and lab records. The co-
construction of this proposal between university researchers and health system stakeholders enhances the
potential for significant and sustainable change for effective and efficient screening and early detection. There
is a critical need for real-world strategies that can function within rural community health systems to improve
health and reduce disparities.
Terms: <21+ years old><Active Follow-up><Address><Adult><Adult Human><Area><Assess implementation><Behavioral Sciences><CRC screening><Cancer Burden><Cancer Cause><Cancer Control><Cancer Control Science><Cancer Etiology><Cancers><Caring><Cessation of life><Clinic><Clinical><Clinical Medical Sciences><Clinical Medicine><Collaborations><Colonoscopy><Colorectal Cancer><Community Health Systems><Computerized Medical Record><County><Data><Death><Death Rate><Decrease disparity><Diagnostic><Early Diagnosis><Economics><Electronic Health Record><Electronic Medical Record><Eligibility><Eligibility Determination><Epidemiology><Evaluation><Evidence based intervention><Face><Fecal Occult Blood Test><Fecal occult blood><Federally Qualified Health Center><Generalized Growth><Growth><Guaiac Smear Test><Health Care Providers><Health Care Systems><Health Catchment Area><Health Personnel><Health Service Area><Health system><Healthcare><Healthcare Providers><Healthcare Systems><Healthcare worker><Hemoccult><Hot Spot><Household><Illinois><Implementation assessment><Impoverished><Incidence><Intervention><Intervention Strategies><Intervention Studies><Interview><Investigators><Lower disparity><Malignant Neoplasms><Malignant Tumor><Measures><Medical><Medically Underserved Area><Mississippi><National Cancer Burden><Outcome><Outcome Measure><Patient Care><Patient Care Delivery><Patients><Population><Poverty><Primary Care><Process><Proctor evaluation model><Proctor framework><Proctor multi-level outcomes framework><Proctor multilevel outcomes framework><Proctor process outcomes><Proctor taxonomy><Protocol Screening><Provider><Qualitative Methods><Randomized><Recommendation><Records><Research Design><Research Personnel><Research Resources><Researchers><Resources><Rural><Rural Community><Screening Result><Service area><Site><Stool guaiac test><Study Type><Survey Instrument><Surveys><Test Result><Testing><Time><Tissue Growth><Travel><U.S. Preventative Services Task Force><U.S. Preventative Task Force><U.S. Preventive Services Task Force><U.S. Preventive Task Force><US Preventative Services Task Force><US Preventative Task Force><US Preventive Health Services Task Force><US Preventive Services Task Force><US Preventive Task Force><USPSTF><United States><United States Preventative Services Task Force><United States Preventative Task Force><United States Preventive Services Task Force><United States Preventive Task Force><Universities><Washington><Work><active followup><adulthood><annual screening><behavior change><cancer care><cancer disparity><cancer health disparity><cancer prevention><cancer-related health disparity><care delivery><care for patients><care of patients><caring for patients><colon cancer detection><colon cancer screening><colorectal cancer detection><colorectal cancer early detection><colorectal cancer screening><data diversity><design><designing><detect colon cancer><detect colorectal cancer><disparity in cancer><disparity in health><disparity reduction><diverse data><early detection><economic><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><epidemiologic><epidemiological><evaluate implementation><evaluation of implementation><experience><faces><facial><follow up><follow-up><followed up><followup><framework by proctor><health care><health care personnel><health care service><health care settings><health care worker><health disparity><health provider><health workforce><healthcare personnel><healthcare service><healthcare settings><heme occult blood test><implementation evaluation><implementation outcomes><implementation science><improved><intervention effect><intervention research><interventional research><interventional strategy><interventional study><interventions research><malignancy><measurable outcome><medical college><medical personnel><medical schools><medically under served><medically under served area><medically underserved><mitigate disparity><mortality><mortality rate><mortality ratio><multidisciplinary><neoplasm/cancer><ontogeny><outcome measurement><patient registry><primary care clinic><primary care provider><primary care setting><primary outcome><proctor conceptual model><proctor implementation><proctor model><providers from primary care><providers of primary care><qualitative reasoning><randomisation><randomization><randomly assigned><reduce disparity><reduction in disparity><response><routine screening><rural area><rural dwellers><rural health care><rural healthcare><rural location><rural region><rural resident><rural under served><rural underserved><school of medicine><screening><screenings><secondary outcome><study design><suburb><suburban><suburbia><success><treatment provider><trial design><uptake>