Breast and Colorectal Cancer Screening Implementation Project (BCCSIP): Cycle I

The Breast and Colorectal Cancer Screening Implementation Project (BCCSIP) FY22-23 reflects a collaborative effort between the Department of Health Care Services (DHCS) Every Woman Counts (EWC) program, the California Department of Public Health (CDPH) Comprehensive Cancer Control Program (CCCP), the California Dialogue on Cancer (CDOC), and the California Colorectal Cancer Coalition (C4). This project is funded by the Centers for Disease Control and Prevention (CDC) with funding for California Federally Qualified Health Centers (FQHC) starting on June 1, 2023. This pilot project provides funding to FQHC based in California that are EWC providers to help them improve their screening rates in both breast and colorectal cancer (CRC) through expanded use of evidence-based interventions (EBI) on clinic populations of similar age (50-74 years old for breast cancer, 45-75 years old for colorectal cancer). An additional requirement of funding is that the applicant organization is required to designate an EBI clinic champion, an advocate in the clinic who provides support to clinic staff implementing the EBI, as a key component of the application. Project outcomes will be evaluated with the aim to increase screening rates, decrease the number of patients diagnosed with late-stage disease, and reduce the overall mortality in patients provided care through FQHC.

The BCCSIP is pleased to announce the following FQHC successfully navigated the merit review process and began their projects on June 1, 2023. We distributed $98,562 for the Cycle I awards.

In alphabetical order:

Bartz-Altadonna Community Health Center

Project Director: Jackie Diaz, LVN
Project Title: Breast Colon Cancer Early Detection Program
Amount Funded: $15,000
Breast Cancer EBI:

1. Increase community access

2. Increase provider delivery

CRC EBI:

1. Increase community demand

2. Increase provider delivery

Location City: Lancaster
Location County: Los Angeles

BACHC will increase its breast cancer screening rate from 44% to 60% of women between the ages of 45-74 during this grant funding opportunity cycle. The colon cancer screening rate will be increased from 29% to 40% over the course of this grant period. These increases will be achieved by using interventions focusing on greater community access by reducing administrative barriers, providing application and scheduling assistance, the use of vouchers if necessary to help clients keep their appointments, and by dedicated care teams managing breast cancer screenings. Colon cancer screenings increases will be achieved by purchasing FIT tests and offering these to clients who are on a sliding scale discount and those whose insurance does not cover this test. BACHC will also be reimbursing the lab who performs the analysis.

BACHC will be creating dedicated staff to perform both breast and colon cancer screenings and referrals AND is in the process of creating a new department, Patient Access. The care teams will include clinicians who will do the actual exams which, in terms of scheduling, can be done as a stand alone appointment or as part of a physical exam. Patient Access staff will provide clients with scheduling assistance and transportation (BACHC has a mobile van that can be used to transport clients). The care teams will further provide education, follow-up and follow through with any necessary referrals.

BACHC will be creating dedicated staff to perform both breast and colon cancer screenings and referrals AND is in the process of creating a new department, Patient Access. The care teams will include clinicians who will do the actual exams which, in terms of scheduling, can be done as a stand alone appointment or as part of a physical exam. Patient Access staff will provide clients with scheduling assistance and transportation (BACHC has a mobile van that can be used to transport clients). The care teams will further provide education, follow-up and follow through with any necessary referrals.

If client surveys demonstrate the need, hours of service will be changed to accommodate this.

Community Health Systems, Inc.

Project Director: Lori N. Holeman, MBA
Project Title: Breast and Colorectal Cancer Screening Implementation Project
Amount Funded: $15,000
Breast Cancer EBI:

1. One-on-one Education

2. Client Reminders

3. Providing Transportation (Breast and CRC)

CRC EBI:

1. One-on-one Education

2. Client Reminders

3. Providing Transportation (Breast and CRC)

Location City: Moreno Valley
Location County: Riverside

Community Health Systems, Inc. (CHSI) is a nonprofit, 501(c)(3), Federally Qualified Health Center (FQHC), operating six stand-alone community health centers, one School Based Health Center, and one mobile medical unit in the tricounty areas of San Bernardino, Riverside, and North Inland San Diego. CHSI has provided uninterrupted primary and preventative health care services since 1984 and has grown from an average of 1,900 patients to more than 24,000 patients in 2022. In 2022, CHSI re-certified and maintained its Level 3 recognition as a Patient-Centered Medical Home (PCMH) organization for five (5) of its health centers. CHSI’s health centers provide primary and preventative medical care, women’s health services, behavioral health, dental care, vision care, chiropractic care, health education services, and community outreach programs to all community residents regardless of their ability to pay. In response to the ongoing COVID-19 public health emergency, CHSI has expanded and enhanced its telehealth service delivery model, in addition to COVID-19 rapid testing and treatment, and vaccinations at all six health centers. CHSI aims to increase the organization’s current breast cancer screening rate from 45.50% to 50% and colorectal screening rate from 33.70% to 40%, across its six health centers. Increasing screening rates will be achieved by enhancing current interventions that are already being implemented in the health centers as well as incorporating new evidence based interventions. CHSI’s current screening efforts for specifically breast and colorectal cancer include one-on-one education, reducing administrative barriers, and provider reminders. CHSI proposes to use funding from this grant to enhance one-on-one education through education and resources offered by Providers, Nurses, and the EBI Clinic Champion. Client reminder interventions will be implemented by sending out messages to eligible patients who are due for screenings. Providing transportation for patients will be a newly implemented interventions for breast & colorectal screening efforts. This service will be used in order to reduce barriers for patients who are seeking screening services.

Gardner Health Services

Project Director: Olegario Avalos Lopez RN BSN
Project Title: The Breast and Colorectal Cancer Screening Implementation Project
Amount Funded: $15,000
Breast Cancer EBI:

1. Client Reminders

2. Provider Assessment & Feedback

CRC EBI:

1. Client Reminders

2. Provider Assessment & Feedback

Location City: San Jose
Location County: Santa Clara

This initiative will use quality improvement activities to improve breast and cervical cancer screening rates and to influence the UDS quality measures.

The Continuous Quality Improvement Director will lead and direct process and overall quality improvement activities that produce better patient outcomes that

1. increases the number of women ages 50+ who have completed a mammogram to screen for breast cancer and

2. increases the number of individuals ages 50-75 who have completed their colorectal cancer FIT test.

Under the direct supervision of the CQI Director and Medical Director the team will develop this initiative and will review and evaluate patient care and outcomes. The data analytics manager will design impact metrics, Mammogram Registry report, CRC Registry report and oversee the analyses that will help drive improvement activities.

The initiative will utilize will leverage OCHIN Epic to track patient compliance of appropriate screenings and follow-up communications on outstanding mammogram referrals and unreturned FIT kits. The team will use reports and analyses to support meeting impact metric goals.

Mammograms: All noncompliant women ages 50+ will be mailed via USPS an introductory letter detailing the mammogram screening initiative. Currently 1,105 women are non-compliant. Every 6-weeks the patient will received a reminder, via text or postcard, to complete their outstanding mammogram order.

FIT Kit: All noncompliant patients between the ages of 50-75 will be mailed via USPS an introductory letter detailing this initiative. Every 6-weeks the patient will received a reminder, via text or postcard, to return their FIT Kit either by taking into the health center or mailing the sample back.

North East Medical Services Project

Director: Kenneth B. Tai, MD
Project Title: NEMS Breast Cancer and Colorectal Cancer Screening Project
Amount Funded: $20,000

Breast Cancer EBI:

1. Multilingual educational brochures will be created about
   mammogram/breast cancer screening (importance, age group, setting up
   appointments, next steps, signs & symptoms, etc.). Digital version of the
   brochure will also be shared via EBI #2: Text Reminders.

2. Text reminders will be sent to patients related to their mammogram/breast
   cancer screening on a monthly basis. Reminders will be sent to patients
   when they are:

   • • a no-show to their scheduled mammogram appoitnment,

     • due for annual screening/mammogram appointment,

     • due for annual screening/mammogram, and

     • in need of follow-up appointment with PCP after an abnormal mammogram screening result.

CRC EBI:

1. Multilingual educational brochures and educational materials will be created
   about colorectal cancer screening (importance, age group, what a positive
   FIT results mean, signs & symptoms next steps, setting up appointments,
   etc.). Digital version of the brochure will also be shared via EBI #2: Text
   Reminders

2. Text reminders will be sent to patients reminding them to complete their
   colorectal cancer screenings and necessary follow up. Reminders will be
   sent to patients monthly when they are:

   • • due for their routine FIT test; and biweekly when they

     • test positive on

Location City: Daly City
Location County: San Mateo

North East Medical Services (NEMS) is one of the largest Federally Qualified Health Centers targeting medically underserved, low-income, and uninsured/underinsured populations of the San Francisco Bay Area. NEMS’s mission is to provide affordable, comprehensive, compassionate and quality health care services in a linguistically competent and culturally sensitive manner to improve the health and well-being of our community. NEMS serves nearly 69,000 patients annually. Of these patients, 88% are Asian, many of whom are new immigrants from China, Hong Kong, Taiwan, and Vietnam. Most patients are monolingual in Chinese or other Asian languages, with 79.5% of all patients best served in a language other than English.

Colorectal cancer (CRC) is the second most commonly diagnosed cancer and the third highest cause of cancer-related mortality among Asians. Culturally influenced assumptions about colorectal health and socioeconomic barriers to accessing health care are some reasons that Asians are reluctant to get screened for CRC. Since 2014, NEMS has made it an organizational priority to improve or maintain high CRC screening rates. We have achieved a remarkable increase in CRC screening rates among our patients ages 50 to 75 from 55% in 2014 to 84% in 2022. This is higher than the Healthy People 2030 goal (74.4%) and significantly higher than the national average (41.93%) among Community Health Centers (federal Uniform Data Systems or UDS data, 2021). NEMS’ high screening compliance shows that our education efforts are effective in raising awareness of CRC and mobilizing our patients to get recommended screenings.

NEMS also continues to reduce barriers and disparities in breast cancer screening access and mortality for our patients. Breast cancer has the highest cancer death rate among Asian women, mostly due to the lack of routine screenings: only 57.8% of Asian women ages 40 and over have had a mammogram within the past two years, compared to 68% of non-Hispanic white women. Screening rates tend to also be lower for Asians who are immigrants, uninsured, or monolingual. For NEMS, some of our challenges for increasing breast cancer screening rates include patients’ hesitation to be screened due to cost/lack of insurance coverage, cultural beliefs against screening, and long wait times for onsite screenings due to high demand for our services. Our breast cancer screening rate for women ages 50-74 was 71% in 2022, which is lower than the Healthy People 2030 goal (80.5%) but higher than the national average (46.29%) among Community Health Centers.

The proposed NEMS Breast Cancer and Colorectal Cancer Screening Project” will focus on increasing community demand and compliance rates for breast cancer and colorectal cancer screenings among our patients. NEMS will increase patient knowledge about the two screenings through the creation and utilization of updated educational materials in English, Chinese, Spanish and Vietnamese. We will also introduce an easier method of reminding patients to return to NEMS for routine or follow-up care through multilingual text messaging reminders. We hope to increase breast cancer screening rates to 73% and maintain our high CRC screening rates by the end of the project period.

The Achievable Foundation

Director: Michelle Catanzarite, MD
Project Title: Improving Cancer Screening and Follow-up For Underserved Community Members
Amount Funded: $18,562

Breast Cancer EBI:

1. Increase Community Demand & Access – Provide targeted case management for patients who are overdue for breast cancer screening to reduce barriers and ensure testing is completed.

2. Increase Provider Delivery – Provide each provider with their rate of breast cancer screening and the rates of their colleagues.

CRC EBI:

1. Increase Community Demand & Access – Provide targeted case management for patients who are overdue for colorectal cancer screening to reduce barriers and ensure testing is completed.

2. Increase Provider Delivery – Increase consistency of provider recommendation for colorectal cancer screening.

Location City: Culver City
Location County: Los Angeles

The Achievable Foundation (Achievable) is an FQHC located in Culver City, California. Achievable’s mission is to provide high quality, integrated health care to individuals with intellectual and developmental disabilities (I/DD), their families, and other vulnerable populations. As an FQHC, Achievable is dedicated to providing primary care, behavioral health care, and enabling services to over 2,300 community members annually. Achievable’s service area spans 28 adjacent zip codes in Los Angeles County, and its target population includes residents who live in households with low income levels, as well as individuals with I/DD and their families.

Throughout the service area, Achievable’s target population experiences extensive health disparities, including disparities in breast and colorectal screening rates. When looking at cancer screening rates by race and ethnicity, service area residents who are African American or Latinx have the lowest screening rates for colorectal cancer, and Asian women have the lowest mammogram rates in the service area. Individuals with I/DD represent a significantly underserved population, especially in preventive care services. Females with I/DD are less likely to have regular mammograms than the general population of women, and individuals with I/DD are almost twice as likely to not receive colorectal cancer screening according to guidelines when compared to people without disabilities. Poor screening leads to a greater cancer burden, negative effect on quality of life, and higher cancer mortality rates.

The overall goal of the current project is to improve screening rates for both breast and colorectal cancer for medically underserved patients, especially individuals with I/DD, patients with low-income, and people of color. Achievable will utilize multicomponent interventions which include activities to increase community demand, increase community access, and increase provider delivery. First, Achievable aims to increase the percentage of women ages 50-74 years old who have a breast cancer screening according to national guidelines to 75%. Second, Achievable aims to increase the percentage of patients ages 45-75 years old who have a colorectal screening according to national guidelines to 70%. Interventions that will be used to achieve the project goal and objectives will include:

1. Creation of a registry within the electronic health record to identify patients due for cancer screenings and conduct outreach;

2. Provision of targeted case management for patients due for cancer screening. Case management includes patient education, referral coordination, appointment scheduling assistance, reminder phone calls, and assistance with overcoming barriers to care;

3. Provider training around how to educate the patient and offer screening choices, the importance of provider recommendations for screenings, and provision of consistent screening orders; and

4. Provider assessment and feedback. By facilitating equitable access to timely screenings for patients, this project will contribute to higher rates of early detection and treatment of cancer, reduction in health disparities, and reduction in cancer mortality among underserved patients.

Western Sierra Medical Clinic

Director: Kirsten George, PA-C
Project Title: Better Health Together
Amount Funded: $15,000

Breast Cancer EBI:

1. Train existing staff resources to perform outreach to patients meeting the criteria of the BCS measure

2. Order mammogram through clinic standing orders.

CRC EBI:

1. Train existing staff resources to perform outreach to patients meeting the criteria of the CCS measure

2. Educate patients and order FIT and or Colonoscopy through clinic standing orders

Location City: Grass Valley
Location County: Nevada

Western Sierra Medical Clinic, Inc. is a 501(c) 3 non-profit federally qualified health center in rural California, operating six locations that serve Nevada, Sierra, Placer, and Yuba counties. During its over 38 years in operation, Western Sierra has provided high-quality primary care services in a manner responsive to the needs of our communities. Western Sierra has a QI process that involves a QI team to create action plans, implement plans, and report on them, create documentation of progress on specific measures that are shared with staff, board members, granters, and insurance companies. We use the Plan, Do, Study, Act (PDSA) method for all quality measures. We will use a PDSA for both BCS and CCS measures to measure the baseline of each measure and track all progress and through each stage of the improvement process of our implementation plan. We will monitor our progress through our monthly reporting process, this will allow us to evaluate our workflows and make necessary adjustments to achieve outcomes.