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Grant Details

Grant Number: 5UH3CA233314-03 Interpret this number
Primary Investigator: Martinez, Maria
Organization: University Of California, San Diego
Project Title: CRC-HUB-SPOKE: a Colorectal Cancer Screening Hub for Southern California Community Health Centers.
Fiscal Year: 2021


Abstract

Colorectal cancer (CRC) screening and appropriate follow-up can reduce incidence and mortality. The US Preventive Services Task Force (USPSTF) recommends CRC screening through a variety of invasive and non-invasive tests for individuals aged 50 to 75 years. Evidence-based interventions (EBIs) and other strategies exist to promote CRC screening, but adoption and implementation of these are limited, especially in CHCs. Our hypothesis is that a Hub and Spoke multilevel intervention will be superior to usual care. The hub will be Health Quality Partners of Southern California (HQP), a non-profit organization comprised of 16 CHC systems (spokes), serving 135 rural and urban clinic sites. We propose a 2-phase study to pilot and optimize (Phase I) and rigorously test (Phase II) the Hub and Spoke approach and its impact on CRC screening, follow-up, and usual care. UG3 Planning/Exploratory Phase AIM: Pilot test the feasibility, acceptability, and preliminary outcomes of a multilevel intervention for CRC screening, follow-up, and referral-to-care using a mixed methods approach. The intervention includes HQP hub-based delivery of centralized mailed FIT to patients served by individual CHCs-spokes plus complimentary provider and clinic-level interventions at CHCs, and coordination of a standardized navigation strategy delivered by CHCs for abnormal FIT follow-up. UH3 Implementation Phase. We will conduct a 2-arm pragmatic randomized trial to assess impact of a regionally-developed multilevel intervention to increase CRC screening, follow-up, and referral-to-care among CHC patients. The trial will be guided by the Pragmatic, Robust Implementation and Sustainability Model (PRISM), which includes outcomes from the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and expands them with contextual constructs. Aim 1. Assess effectiveness of the multilevel intervention based on: 1) improvement in proportion up-to-date with screening 3 years post implementation; 2) proportion with abnormal FIT who complete diagnostic colonoscopy within 6 months; and 3) proportion with CRC completing first treatment evaluation. Aim 2. Evaluate the implementation, scalability, and sustainability of a multilevel implementation strategy. Implementation will be evaluated with a mixed methods approach using the RE-AIM outcomes of Reach, Adoption, and Implementation as well as the PRISM constructs of Intervention Characteristics and Recipients from perspective of multiple stakeholders (i.e. patients, front-line staff, and operational leaders). We will also calculate replication costs. Scalability and Sustainability will be evaluated using the RE-AIM outcome of Maintenance and the PRISM constructs of Implementation & Sustainability Infrastructure and External Environment. Our study will help accelerate progress in CRC prevention in underserved populations by identifying multilevel intervention strategies that are scalable to additional CHCs in the region, with potential for larger scale implementation.



Publications

The COVID-19 Pandemic: Identifying Adaptive Solutions for Colorectal Cancer Screening in Underserved Communities.
Authors: Nodora J.N. , Gupta S. , Howard N. , Motadel K. , Propst T. , Rodriguez J. , Schultz J. , Velasquez S. , Castañeda S.F. , Rabin B. , et al. .
Source: Journal of the National Cancer Institute, 2021-08-02; 113(8), p. 962-968.
PMID: 32780851
Related Citations

Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality.
Authors: San Miguel Y. , Demb J. , Martinez M.E. , Gupta S. , May F.P. .
Source: Gastroenterology, 2021 05; 160(6), p. 1997-2005.e3.
EPub date: 2021-02-02.
PMID: 33545140
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Systematic Review of Prevalence, Risk Factors, and Risk for Metachronous Advanced Neoplasia in Patients With Young-Onset Colorectal Adenoma.
Authors: Enwerem N. , Cho M.Y. , Demb J. , Earles A. , Heskett K.M. , Liu L. , Singh S. , Gupta S. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2021 04; 19(4), p. 680-689.e12.
EPub date: 2020-05-16.
PMID: 32428708
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An Update on the Epidemiology, Molecular Characterization, Diagnosis, and Screening Strategies for Early-Onset Colorectal Cancer.
Authors: Burnett-Hartman A.N. , Lee J.K. , Demb J. , Gupta S. .
Source: Gastroenterology, 2021 03; 160(4), p. 1041-1049.
EPub date: 2021-01-05.
PMID: 33417940
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Young-onset colorectal cancer risk among individuals with iron-deficiency anaemia and haematochezia.
Authors: Demb J. , Liu L. , Murphy C.C. , Doubeni C.A. , Martínez M.E. , Gupta S. .
Source: Gut, 2020-12-18; , .
EPub date: 2020-12-18.
PMID: 33443020
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Population-Based Analysis of Differences in Gastric Cancer Incidence Among Races and Ethnicities in Individuals Age 50 Years and Older.
Authors: Shah S.C. , McKinley M. , Gupta S. , Peek R.M. , Martinez M.E. , Gomez S.L. .
Source: Gastroenterology, 2020 11; 159(5), p. 1705-1714.e2.
EPub date: 2020-08-06.
PMID: 32771406
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Screening and Surveillance Colonoscopy and COVID-19: Avoiding More Casualties.
Authors: Gupta S. , Lieberman D. .
Source: Gastroenterology, 2020 10; 159(4), p. 1205-1208.
EPub date: 2020-07-16.
PMID: 32682766
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Risk Factors for Early-Onset Colorectal Cancer.
Authors: Low E.E. , Demb J. , Liu L. , Earles A. , Bustamante R. , Williams C.D. , Provenzale D. , Kaltenbach T. , Gawron A.J. , Martinez M.E. , et al. .
Source: Gastroenterology, 2020 08; 159(2), p. 492-501.e7.
EPub date: 2020-01-09.
PMID: 31926997
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Mailed fecal immunochemical test outreach for colorectal cancer screening: Summary of a Centers for Disease Control and Prevention-sponsored Summit.
Authors: Gupta S. , Coronado G.D. , Argenbright K. , Brenner A.T. , Castañeda S.F. , Dominitz J.A. , Green B. , Issaka R.B. , Levin T.R. , Reuland D.S. , et al. .
Source: CA: a cancer journal for clinicians, 2020 07; 70(4), p. 283-298.
EPub date: 2020-06-25.
PMID: 32583884
Related Citations

Racial and Ethnic Disparities in Colorectal Cancer Screening Pose Persistent Challenges to Health Equity.
Authors: Demb J. , Gupta S. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2020 07; 18(8), p. 1691-1693.
EPub date: 2019-11-29.
PMID: 31786329
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Who Is Reached With Clinic In-Reach and Outreach Strategies to Promote Colorectal Cancer Screening?
Authors: Coronado G.D. .
Source: American journal of public health, 2020 04; 110(4), p. 437-439.
PMID: 32159997
Related Citations

Outreach and Inreach Strategies for Colorectal Cancer Screening Among Latinos at a Federally Qualified Health Center: A Randomized Controlled Trial, 2015-2018.
Authors: Castañeda S.F. , Bharti B. , Rojas M. , Mercado S. , Bearse A.M. , Camacho J. , Lopez M.S. , Muñoz F. , O'Connell S. , Liu L. , et al. .
Source: American journal of public health, 2020 04; 110(4), p. 587-594.
EPub date: 2020-02-20.
PMID: 32078353
Related Citations

AGA Clinical Practice Guidelines on Management of Gastric Intestinal Metaplasia.
Authors: Gupta S. , Li D. , El Serag H.B. , Davitkov P. , Altayar O. , Sultan S. , Falck-Ytter Y. , Mustafa R.A. .
Source: Gastroenterology, 2020 02; 158(3), p. 693-702.
EPub date: 2019-12-06.
PMID: 31816298
Related Citations

Does Colon Polyp Surveillance Improve Patient Outcomes?
Authors: Lieberman D. , Gupta S. .
Source: Gastroenterology, 2020 01; 158(2), p. 436-440.
EPub date: 2019-10-12.
PMID: 31614123
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