DESCRIPTION (provided by applicant): Cancer screening rates among low income and minority populations remain well below optimal levels. The National Cancer Collaborative Demonstration Project, sponsored by HRSA and NCI, has begun to apply the Chronic Care Model, which has effectively transformed care for diabetes and asthma, to cancer screening. This is a significant challenge, because the population that is appropriate for screening services is so much larger than defined populations of those with chronic disease. Thus, it is likely that additional interventions and supportive services will be needed to reach optimal screening targets because of the scale and magnitude of the screening challenge. Use of a community-based participatory research strategy will increase our ability to address these challenges, and to make a meaningful impact on disparities in cancer screening, and ultimately in cancer incidence and mortality. The proposed study aims to evaluate sustainable strategies for maximizing cancer screening rates among populations facing significant cancer disparities. Using a community-based participatory approach, we will develop and implement the interventions in partnership with Whittier Street Health Center, which has implemented systems redesign according to the Chronic Care Model for cancer screening. A two-group randomized control trial design will be used, comparing: (1) the on-going systems redesign, which now represents usual care at this and many HRSA health centers; and (2) system redesign plus an interactive voice response scheduling and reminder system that can be integrated with the health center's appointment system and community health worker follow-up of individuals who do not respond to the IVR system. Key outcomes include: (1) no show rates at scheduled health care visits; and (2) screening rates for breast, cervical, colorectal cancer, and decision-making for prostate cancer screening. We will work with our community partners to adapt the most effective intervention based on the RCT and offer it to community health centers in Boston and Los Angeles that are part of community-based research networks in which we participate. We will evaluate factors influencing adoption and implementation of the intervention in this dissemination phase.
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