- Mission Neighborhood Health Center
- Neighborhood Healthcare
- Northeast Valley Health Corporation (NEVHC)
- Vietnamese American Cancer Foundation
- Vista Community Clinic
Mission Neighborhood Health Center
Project Director: Brad Williams, M.D
Organization Headquarters: San Francisco, CA
Amount Funded: $10,000
Project Title: Increasing Colorectal Cancer Screenings among Latinx
Mission Neighborhood Health Center (MNHC) was founded in 1960. MNHC recently acquired Mission Bernal clinic. Over time, MNHC expanded its services from primary care to include: dental and optometry, MNHC is a Patient Centered Medical Home. To best serve the community, MNHC now has five locations serving patients in the Mission District area. MNHC served 13,000 patients and community members every year.
Researchers from the University of Colorado School of Medicine analyzed data from more than 100,000 people with adenocarcinoma and found that young patients 20-29 years old have had the highest increase in rates of new colon cancer cases diagnosed and are most like to be in the distant stage of cancer when diagnosed. In particular, subgroups of non-Hispanic Black and Hispanic participants had the highest increases. MNHC aims to increase colorectal cancer screening rates from 44% in December 2021 to 48% by April 2023. To achieve a screening rate of 48%, MNHC will need to screen an additional 100 patients. MNHC proposes implementing interventions with a focus on 1) increased community awareness, 2) increased screening delivery, and 3) increased community access.
MNHC’s first objective is to increase community awareness by conducting outreach and follow-ups. To achieve this goal, MNHC will place colorectal cancer screening infographics in exam rooms across all clinics to reach the eligible population. MNHC will ensure that the informational materials are translated to Spanish in order to reach our patient population. MNHC’s second objective is to increase screening delivery. To achieve this goal, MNHC will implement mailing FIT kits to patients who are due and have an upcoming appointment. It is important to ensure that MNHC includes return envelopes and appropriate language for instructions. MNHC’s third objective is to increase community access. To achieve this goal, MNHC will ensure that the referral team provides reports on up-to-date patient status for outreach staff to follow up accordingly. Any patients that are unable to receive and/or return their FIT kits will be assisted.
Clinic staff will receive in-service training to review documentation of kits given, kits returned, FIT kit results, and colonoscopy referrals. Outreach staff will receive motivational interviewing training to advocate for the importance of colorectal cancer screenings. MNHC will be transitioning from NextGen, our current electronic health record system, to EPIC and will possibly be using Tableau as a data analytic tool to help track project activities
Project Director: Michelle M. Hughes, PharmD, BCPS, BCACP
Organization Headquarters: Escondido, CA
Amount Funded: $10,000
Project Title: Restoring FIT Return Rates
Neighborhood Healthcare’s Restoring FIT Return Rates project will re-establish the number of patients who receive this critical test to our pre-COVID percentage of the patient population. COVID’s impact on our patient’s completion of FIT kit testing has been significant, decreasing completed tests from 61% of the eligible patient population to 50%. This program aims to restore, sustain, and establish processes to improve upon an organization-wide FIT return rate of 61%. In addition, we aim to increase the CRC follow-up screening record rate by 10% from 27% to 37%.
In a recent needs assessment conducted by the Neighborhood’s Director of Quality and Population Health, several areas for improvement were identified: first, barriers to FIT kit testing returns have increased beyond transportation due to changes in the delivery of medical services, including telehealth; second, the turnover and shortage of Medical Assistants due to COVID, requires refresher training on the importance of follow up for FIT kit testing; and lastly, the need for designated staff to support site leadership in holding their team accountable for rates is critical to success. We aim to improve FIT return rates and overall CRC screening rates by addressing these needs.
The neighborhood will provide FIT kits to all eligible patients with postage prepaid for return, and patients receiving telehealth care will receive theirs in the mail. Our training team will ensure that all Medical Assistants know current FIT kit instructions. Training will include notifying patients to return theirs as soon as possible with their next bowel movement and observing the follow-up protocol beginning seven days after supplying the test. In addition, the Director of Quality and Population Health will establish an outreach protocol to include Neighborhood’s Mobile Health program and utilize bundled initiatives such as FluFit (with Flu shots) and GluFit (with Glucose Testing for diabetic patients) approaches to reach more patients outside of primary care appointments. We will also expand the target age range to include patients aged 45-49 to meet the United States Preventive Services Task Force (USPSTF) recommendations. Finally, local leadership will hold their teams accountable for their FIT return rate and overall screening rates to meet objectives set in our established quality incentive program for staff.
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)
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 13,573 patients 50-75 years of age who complete a colorectal cancer screening from a baseline of 46.5% in December 2021 to 56.5% by February 2023. 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 10 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 new 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); 3) calling NEVHC Canoga Park and Santa Clarita Health Center in-person and virtual patients who were missed, and 4) sending new FIT kits to missed patients who requested them through text or phone call.
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.
Vietnamese American Cancer Foundation
Project Director: Dung Hua, MHA
Organization Headquarters: Fountain Valley, CA
Amount Funded: $10,000
Project Title: Colorectal Cancer Prevention & Detection Project
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. VACF was founded by local cancer survivors, physicians, and volunteers who recognized the need for culturally and linguistically appropriate cancer support and resources in underserved communities. 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.
VACF’s Colorectal Cancer Prevention & Detection Project strives to increase colorectal cancer (CRC) screening through individual and communal awareness, education, and screening compliance for the underserved communities in Southern California, including the Vietnamese and Hispanic/Latinx. As the third most common cancer diagnosed in both men and women in the United States, colorectal cancer disproportionately affects the underserviced and uninsured communities. Particularly, colorectal cancer ranks third for cancer-related mortality among Vietnamese Americans and is the second and third most common cause of cancer death among Hispanic men and women, respectively. Yet, colorectal cancer screening rate among these communities is historically low. Delayed or missed screening could result in some cancer cases diagnosed at a later stage with a poorer prognosis and fewer effective treatment options. To address colorectal cancer disparities in these communities, VACF’s Colorectal Cancer Prevention & Detection Project aims to mitigate the cultural, financial, and social barriers associated with colorectal cancer when receiving cancer education, screening, care coordination, and psychosocial support. The goal of the project is to destigmatize colorectal cancer in the community through outreach and education, regular screenings, increased access to care, and individual/community empowerment to take ownership over one’s health care decisions.
The Colorectal Cancer Prevention & Detection Project proposes to increase the number of average and high-risk individuals who access colorectal cancer (CRC) screening, increase individual and communal awareness and knowledge about colorectal cancer screening and prevention, and improve access to care by reducing disparities and health inequities, and improve follow-up processes after abnormal primary CRC screening. Bilingual educational materials on the colorectal continuum of care will be disseminated to community members at health fairs and community events, and culturally and linguistically tailored educational workshops will be provided to educate the community about FIT kit use and distribute them with an 80% return rate. Community members will also receive colorectal health information through VACF’s physical and virtual communication channels. VACF’s dedicated staff will provide patient navigation and individualized follow-up care to clients with both normal and abnormal results, 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 Director: Vista Community Clinic
Organization Headquarters: Rajni B. Lopez, MPH
Amount Funded: $10,000
Project Title: Educating staff to improve colorectal cancer screening rate
Through its data, VCC is aware that the pandemic has negatively affected the rate of its patients’ completion of CRCS tests. Added to that, a significant number of patients are not completing the data fields correctly, although this is necessary to ensure that the test will be accepted and processed. VCC understands that one key to increasing and sustaining high rates of CRCS completion is staff education and motivation. In the last two years, a number of factors have affected the staff’s ability to be as effective in promoting CRCS, including staff turnover, interruption of normal training schedules, and the general disruption of the pandemic protocols in-clinic, which has led much relevant staff to forget or disregard the provision of the test materials and related education, and the fact that staff has yet to be trained regarding the change in recommended initial screening age to 45.
Given this understanding, VCC is proposing to use C4 funds to develop and engage in a thorough campaign of staff (re)education regarding all aspects of CRCS, including training staff to educate patients regarding all CRCS aspects, including 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 the distribution and return of CRCS tests among patients who are seen via telehealth. 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 that, the project will ensure that all those patients receiving a positive result receive assistance in completing a diagnostic colonoscopy.