||1UG3CA233314-01A1 Interpret this number
||University Of California, San Diego
||CRC-HUB-SPOKE: a Colorectal Cancer Screening Hub for Southern California Community Health Centers.
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.
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