RCT/Increase Colon Cancer Screening/Medicaid Managed Care

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DESCRIPTION (provided by applicant): Disparities persist in the colorectal cancer screening. There is need for practical, widely applicable interventions that could correct these disparities. Through previous work (R01-87776) we have developed a Prevention Care Management (PCM) intervention based on telephone support that increased colon cancer screening rates for low income women visiting community/migrant health centers in New York City almost two fold. The earlier project relied on research staff to recruit patients in community/migrant health center (C/MHC) waiting rooms and to provide the intervention, thus, limiting its transportability and sustainability. This new project in response to PAR 04-036 will be based in Medicaid Managed Care Organizations (MMCOs) which can provide sustainable, widely available infrastructures to support colon cancer screening especially for women who comprise a substantial majority of MMCO enrollees. Our first aim is to expand the scope of PCM to apply to MMCO-enrolled women who seldom visit primary care (outreach) while continuing to provide inreach to more frequent attenders. The second aim is to conduct a randomized controlled trial of the expanded PCM intervention to assess its impact on colorectal cancer screening status of low-income women age 50-64 years and to describe the process of Prevention Care Management. Several unique features of the project should be noted: the identification of women overdue for screening through MMCO claims data which is both practical to sustain and expands the reach of the project to include women who seldom visit primary care; the intervention will be delivered by established MMCO staff, not researchers appearing transiently but cannot sustain the intervention; outcomes will be assessed through MMCO claims data; and multiple representative MMCOs in New York City will be involved. Colon cancer screening will be promoted in the context of other indicated screening for breast and cervical cancer. Aim three will explore the relationship of characteristics of the women (demographics), of the community/migrant health centers that serve them, and of the MMCOs in which they are enrolled to colorectal cancer screening status including the impact of the intervention. Cost of the intervention and its relationship to increased screening rates will be assessed. The intervention and evaluation are guided by Diffusion of Innovations.