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

The Breast and Colorectal Cancer Screening Implementation Project (BCCSIP) 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 January 1, 2024. 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 January 1, 2024. We distributed $185,000 for the Cycle 2 awards.

Bartz-Altadonna Community Health Center

Project Director: Jackie Diaz, LVN
Project Title: Breast & Colon Cancer Early Detection Program
Amount Funded: $20,000

Location City: Lancaster
Location County: Los Angeles

Breast Cancer EBI:

1. Increase community access

2. Increase provider delivery

CRC EBI:

1. Increase community demand

2. Increase provider delivery

Increase Community Access (EBI 1): Care teams, overseen by Project Director Jackeline Diaz, will assist clients in scheduling appointments, completing applications, and arranging necessary transportation. This initiative aims to increase the number of women screened for breast cancer from 44% to 60% over the funding period. Baseline data and ongoing monthly assessments will gauge the effectiveness, with care managers compiling data and implementing PDSA cycles if needed to demonstrate a 14% increase in breast cancer screening.

Educational Outreach: Through the funding period, educational outreach campaigns led by a Public Relations Specialist will inform clients virtually about available screening programs, and CRBD will provide financial assistance options and resources for the uninsured or underinsured. The goal is to raise awareness and knowledge about these resources. Engagement metrics on social media platforms will be analyzed, with increased likes, shares, comments, and click-through rates indicating heightened awareness. The Public Relations Specialist will update social media platforms to support this effort.

Increased Community Access (EBI 2): To ensure that appointments are readily available, the aim is to boost breast cancer screenings by 14%, achieving a screening rate of 60%. Clinician providers, under the supervision of Project Director Jackeline Diaz, will be responsible for this initiative. Baseline data, collected before and during the intervention, will monitor the utilization of enhanced breast screening services. Data Analyst Christian will provide data support. Appointment templates and Electronic Health Record (EHR) modifications will be implemented in the first month of funding. The intervention will commence in month 2, with ongoing monthly evaluations, targeting a 14% increase in breast cancer screenings.

Using Alternative Screening Sites (Mobile Mammography Units): Collaboration with two community imaging centers will facilitate the deployment of mobile mammography units to reach underserved and rural areas, making screenings more convenient and reducing travel costs. Project Director Jackeline Diaz oversees the Care Team, and Data Analyst Christian provides data support. The initiative involves scheduling patients on a weekly basis and optimizing patient mapping within the same geographic area. Data will be tracked monthly through EHR to assess the success of this approach.

Coppertower Family Medical Center dba Alexander Valley Healthcare

Project Director: Brianna Ketzer

Project Title: Screening for a Healthier Community

Amount Funded: $20,000

Location City: Cloverdale

Location County: Sonoma County

Breast Cancer EBI:

1. EBI team readiness – Improving Provider Delivery

2. Client education and outreach

3. Evaluation of effectiveness

CRC EBI:

1. EBI team readiness – Improving Provider Delivery

2. Client education and outreach

3. Evaluation of effectiveness

AVH plans to utilize staff time to make a concerted outreach to patients who are due for BC and CRC screenings, scheduled or designated time for making calls, ordering screenings, faxing orders, sending CRC screening kits through the mail, following up to educate, answer questions, remind patients and encourage completion.

Gardner Family Health Network, Inc. 

Project Director: Olegario Avalos Lopez RN BSN

Project Title: Increasing BC and CRC Cancer Screenings and Early Detection

Amount Funded: $20,000

Location City:  San Jose

Location County: Santa Clara County

Breast Cancer EBI:

1. Patient Reminders

2. Provider Assessment & Feedback

CRC EBI:

1. Client Reminders

2. Provider Assessment & Feedback

For this second funding cycle, the Continuous Quality Improvement Director will guide the next phase of this initiative. The initiative will continue to build on the work of the previous funding cycle. With goals to 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 in partnership and with clinical support from the Medical Director, the team continue to expand this initiative and ensuring its success through regularly reviewing and evaluating initiative outcomes. The data analytics manager is responsible for ensuring timely access to the Mammogram Registry, CRC Registry and the analyses that will help drive improvement activities. The Medical Director and providers will evaluate results and use the registries for providers to identify non-compliant patients who  need to be contacted for scheduling.  

The initiative leverages OCHIN-Epic EHR system to collect data that is used to track patient compliance of appropriate screenings, initial/follow-up communications to patients for outstanding mammogram referrals and unreturned FIT kits. The team will use reports and analyses to communicate with providers and patients to meet impact metric goals.

Mammograms

All noncompliant women ages 50+ will be mailed via USPS an introductory letter detailing the mammogram screening initiative. Patients with a referral will be reminded to complete their mammogram and patients who are due for their mammogram will be instructed to schedule an appointment with their provider to obtain their mammogram referral.  Currently 1,213 women are non-compliant. After 6-months, if the patient has not completed their mammogram, 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. Patients who have been provided with a FIT Kit will be reminded to complete and return their FIT Kit to any of the seven (7) health center sites or by mailing the sample back.  Patients who are due for the colorectal screening will be instructed to schedule an appointment with their provider to obtain their FIT Kit.  Currently 1,084 patients are non-compliant. After 6-months, if the patient has not completed and returned FIT Kit, the patient will received a reminder, via text or postcard, to complete and return their FIT Kit either by taking it to one of the seven (7) health center or mailing the sample back.

Mission Neighborhood Health Center 

Project Director: Robert Bradley Williams, MD

Project Title: BC/CRC Care Navigator

Amount Funded: $20,000

Location City: Daly City

Location County: San Mateo County

MNHC plans to achieve evidence-based improvement in breast cancer and colorectal cancer using a few key methods:

• Screening and Early detection by implementing regular screening programs to detect cancer at its earliest, most treatable stage. Mammograms and FIT are common examples

• Quality Metrics: regularly measuring and analyzing treatment outcomes to identify areas for improvement and enhance the quality of care

• Patient Education: Providing patients with comprehensive information about the importance of these screenings by using dedicated navigator

Opertation Samahan, Inc.

Project Director: Archie Bella, MD, MBA

Project Title: Opsam Health Interventions to Improve Colorectal and Breast Cancer Screening Rates

Amount Funded: $20,000

Location City: National City

Location County: San Diego County

Breast Cancer EBI:

1. Increasing Community Access for Colorectal and Breast Cancer Screening - Policy Refinement

2. Increasing Community Access for Breast Cancer Screening - Caller Scripts

CRC EBI:

1. Increasing Community Access for Colorectal and Breast Cancer Screening - Policy Refinement

2. Increasing Community Access for Colorectal Cancer Screening - Caller Scripts

One of our interventions will focus on refining our processes for stratifying risk and standardizing our screening processes. For colorectal cancer, we will be implementing an algorithm that will help us assign eligible patients to fecal-based tests which are less costly and invasive. For breast cancer, we will be evaluating our breast cancer screening procedures in our EMR and assigning a task force to analyze factors contributing to noncompliance. Our next intervention will focus on training our call center representatives to recognize patients who are eligible for breast cancer screening and refer them to Every Woman Counts when they are unable to afford out-of-pocket costs for screening. As a counterpart, we will be training our call center representatives on a script to provide resources for colorectal screening and to encourage follow-up. Our third intervention will make use of existing educational materials on colorectal and breast cancer screening to educate individuals and direct them to our clinics for screening. The materials will be present during our outreach events and for distribution in our clinics. 

Petaluma Health Center

Project Director: Rachel M. Joseph, FNP, MPH

Project Title: BC/CRC Care Navigator

Amount Funded: $35,000

Location City: Petaluma

Location County: Sonoma County

Breast Cancer EBI:

1. Enhanced Provider Reminder/Recall System

2. Reduce Structural Barriers through Enhanced Case Management Efforts

CRC EBI:

1. Enhanced Provider Reminder/Recall System

2. Reduce Structural Barriers through Enhanced Case Management Efforts

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 breast and colorectal cancer screening rates have steadily declined due to the backlog created during the COVID-19 pandemic combined with an influx in patient population. From 2019 to 2022, PHC’s breast cancer screening rates plummeted from 70% to 43%, while colorectal cancer rates slipped 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.

To meet this growing demand for expanded cancer screening services, PHC will launch an initiative aimed at enhancing existing evidence-based interventions (EBI) for breast and colorectal cancer screening. This initiative is designed to bridge the gaps in our service area, which encompasses around 640,655 individuals across Sonoma County and Marin County. To efficiently increase both breast and colorectal cancer screening rates simultaneously, PHC has pinpointed two core EBIs for enhancement: 

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 breast and 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. Through the BCCSIP project, PHC will improve breast and colorectal cancer screening rates, roughly adding a combined 1,068 patients annually for breast and colorectal cancer screening.

The Achievable Foundation

Project Director: Michelle Catanzarite, MD

Project Title: Breast and Colorectal Cancer Screening for Under-resourced Community Members

Amount Funded: $20,000

Location City: Culver City

Location County: Los Angeles County

Breast Cancer EBI:

1. Provider Assessment and Feedback:

2. Reduce Administrative Barriers

CRC EBI:

1. Provider Assessment and Feedback

2. Reduce Administrative Barriers 

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 and under-resourced patients, especially individuals with I/DD, patients with low-income, and people of color. In addition to current activities to increase community access and community demand for cancer screenings, for the current project Achievable will utilize new multicomponent interventions which include activities to 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 77%. 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) Provider and care team assessment and continuous feedback regarding cancer screening rates; 2) Provider education regarding strategies to improve cancer screening rates; and 3) Implementation of standing cancer screening orders as appropriate in order to reduce administrative barriers to cancer screening for patients. By facilitating equitable access to timely screenings for patients, this project will further 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

Project Director: Kirsten George, PA-C

Project Title: Better Health Together

Amount Funded: $30,000

Location City: Grass Valley

Location County: Nevada County

Breast Cancer EBI:

1. Increase Community Demand

2. Increase Community Access

CRC EBI:

1. Increase Community Demand

2. Increase Community Access

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. Our PDSA for both BCS and CCS measures will include patient outreach and education, staff training, internal campaigns with staff, social media, community collaborations, and wellness days with community partners and insurance companies. Our mission is to provide quality care to all regardless of their ability to pay, their race, ethnicity, religion, self-identity, or creed.