Colon cancer is the second-leading cause of cancer death in the United States, and screening rates are disproportionately low among priority populations. Direct-mail FIT programs are shown to improve rates of colon cancer screening and generally involve the mailing of an introductory letter, FIT kit, and reminders to encourage patients to mail back their FIT kit.


Disparities in colorectal cancer (CRC) screening and follow-up exist in rural communities. Disparities are especially prominent in Medicaid and diverse patient populations. In SMARTER CRC, we will adapt, pilot, then test the implementation and scale-up of targeted direct-mail and patient navigation programs. In this project, Oregon Rural Practiced Based Research Network (ORPRN) partners with rural clinics, health plans (payers), and commercial vendors. Here we study how clinics address patient, clinic, and community level factors to reduce CRC disparities in rural communities.

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The Screen to Prevent (STOP) Colon Cancer project is trying to raise colorectal cancer screening rates in Federally Qualified Health Centers (FQHCs). Colorectal cancer is the second-leading cause of cancer deaths. Early detection saves lives, yet too few adults are screened regularly.

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The Participatory Research to Advance Colon Cancer Prevention (PROMPT) study seeks to raise rates of colon cancer screening in safety-net primary care practices and decrease screening disparities in priority populations (minority racial/ethnic and low income individuals). PROMPT is a partnership between the Kaiser Permanente Center for Health Research (CHR), Oregon Health & Sciences University (OHSU), and AltaMed Health Services.

The study will develop and use personalized alert and reminder prompts for a direct-mail fecal immunochemical test (FIT) program in two phases. In Phase 1, we will develop personalized messages using a community-based participatory research process that involves working with patients and providers called boot camp translation. We will test the messages among patients in a pilot study at two AltaMed clinics. In Phase 2, we will spread the program to other AltaMed clinics.

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BeneFIT is a study on health plan-based pilot programs of mailed fecal immunochemical tests (FIT) to increase colorectal cancer screening (CRC) rates among individuals enrolled in Medicaid or who are dual-eligible for Medicaid and Medicare. The study examines the development and implementation of mailed FIT programs by health plans in Oregon and Washington state and compares the successes and challenges faced by two different program models presented by the two health plans. The study was funded by the Centers for Disease Control in September 2015, and will last 4 years. BeneFIT is a partnership among, University of Washington, Kaiser Permanente WA Health Research Institute, and Kaiser Permanente Center for Health Research.

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Sea Mar Community Health Centers is partnering with the Kaiser Permanente Center for Health Research (CHR) on a study to improve rates of follow-up colonoscopy in community health centers.Predicting and Addressing Colonoscopy Non-adherence in Community Settings (PRECISE) is a 5-year study funded by the National Cancer Institute. Dr. Coronado has partnered with Sea Mar in the past on studies related to colorectal cancer screening.

PRECISE will use patient navigation to address low rates of follow-up colonoscopy among patients who screen positive on fecal immunochemical testing (FIT). Navigation will target patients who are predetermined to have a low or moderate chance of completing a colonoscopy on their own. The completion among patients who are unlikely to complete one on their own.

The study is the first of its kind to use as data-driven method of selecting patients for patient navigation. Estimated enrollment is about 1,200 Sea Mar patients who screen positive on a FIT over a two-year period, starting in Spring 2019.

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