Need: Texas Cancer Registry data indicate that compared to Harris County and the state of Texas, Nacogdoches and Shelby counties report higher incidence and mortality attributed to CRC. For the years 2012-2016, the age-adjusted incidence (per 100,000 population) attributed to CRC was significantly higher for Nacogdoches and Shelby (45.7 per 100,000; 45.1 per 100,000, respectively) compared to Harris County and Texas (38.0 per 100,000; 37.7 per 100,000, respectively). Significant disparities can also be observed for mortality rates. For example, age-adjusted mortality for the years 2012-2016 for Nacogdoches and Shelby counties were also significantly higher (18.6 per 100,000; 19.1 per 100,000...

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Need: Texas Cancer Registry data indicate that compared to Harris County and the state of Texas, Nacogdoches and Shelby counties report higher incidence and mortality attributed to CRC. For the years 2012-2016, the age-adjusted incidence (per 100,000 population) attributed to CRC was significantly higher for Nacogdoches and Shelby (45.7 per 100,000; 45.1 per 100,000, respectively) compared to Harris County and Texas (38.0 per 100,000; 37.7 per 100,000, respectively). Significant disparities can also be observed for mortality rates. For example, age-adjusted mortality for the years 2012-2016 for Nacogdoches and Shelby counties were also significantly higher (18.6 per 100,000; 19.1 per 100,000) compared with Harris County and Texas (14.2 per 100,000; 14.2 per 100,000). Although several factors could be contributing to the observed disparity in mortality associated with CRC, there is growing evidence that suggests systems issues rather than tumor biology as culprits, such as poor access the health care (late presentation), and higher frequency of comorbidity. Overall Project Strategy: The proposed CPRIT project will expand a successful Electronic Health Record (EHR) based CRC screening, follow-up and, education program (PP-160122) to a geographic area of the state disproportionately affected by CRC incidence and mortality, Nacogdoches and Shelby counties. Our strategy will include several components: 1) Establish a Rural and Urban Network for Cancer Prevention through Outreach and Education (RUN-CPOE). The RUN-CPOE collaborative will engage the community around CRC prevention and screening education guidelines and improve access to CRC screening services for age-eligible community residents without a current medical home by creating a community-based CRC screening registry; 2) Build a comprehensive patient navigator-led CRC program sensitive to the needs of medically underserved rural and urban populations; 3)Engaging community residents in understanding the importance of timely CRC screening, reducing modifiable CRC risk factors including smoking, alcohol use, physical inactivity, and increase adoption of a healthy diet to include daily fruit and vegetable consumption. Specific Goals: 1) Provide outreach and education regarding CRC prevention and screening guidelines and services to age-eligible community residents served by NMC and BCM. We will develop and implement a culturally and linguistically appropriate community-based program to coordinate outreach and education about CRC prevention and screening guidelines for early detection of CRC in age-eligible community residents served by Nacogdoches Medical Center (NMC) and BCM. Over a three-year project period, we will outreach to approximately 32460 community residents from BCM, and NMC using existing and newly developed CRC education materials, and CRC monologues. We anticipate that 210 professionals will benefit from these materials as well; 2) Implement a patient navigator-led CRC care navigation workbench integrated into the Nacogdoches Medical Center Health Network EHR to increase access to CRC screening services. We expect to navigate a total of 35250 age-eligible community residents to CRC screening completion. From those navigated, we project that a total of 27,000 individuals will actually have documented CRC screening completion the EHR-Based patient navigation (PN) workbench; 3) Improve referral and follow-up for patients with abnormal colonoscopies. Significance and Impact: Non-Metropolitan counties, in particular those encompassing rural communities, often experience greater cancer burden, primarily due to barriers associated with access to care. Residents from rural areas often have limited options for where to receive health care. The nearest health care facility may be a long distance away and such areas may lack reliable public transportation. To address these barriers to efficient and effective care, we are proposing to build a dedicated CRC PN workbench into NMC Health Network EHRs. This workbench, much like the existing one with project PP-160122, will be embedded into the EHR to consistently document and track all aspects of CRC screening and patient navigator (PN)-led CRC education. This includes activities such as initial referral, scheduling and reporting of Fecal Immunochemical Tests (FITs), colonoscopy findings, and documentation of physical and attitudinal barriers to CRC screening. Dedicated CRC PN services in the funded project (PP-160122) have been provided to a total of 34,160 age-eligible individuals from 47 Texas counties. Of this total,19,716 patients received FIT navigation services,and 14,444 colonoscopy navigation services. A total of 23,873 individuals went on to complete CRC screening (FITs, n = 13,128; colonoscopies, n = 10,396; sigmoidoscopies, n = 349). Based on the current project's accomplishments, we are confident that the successes observed with this project will be replicated in rural communities of Texas.

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