Reducing Disparities in Colorectal Cancer Screening through Proactive Outreach and Navigation in federally qualified health care centers in Brooklyn

结直肠癌(CRC)是男性和女性的第三大常见癌症，是第二大常见癌症 癌症相关死亡的主要原因。筛查CRC可降低CRC发病率和 死亡率，建议45岁至75岁的中等风险男性和女性使用 由美国预防服务工作组指南制定；该指南最近进行了更新，包括 45-49岁，美国另外2000万人。纽约市的筛查率 在曼哈顿有78%的人，但在整个联邦合格的健康中心(FQHC)只有26%-55% 向代表不足的少数民族提供免费和补贴医疗服务的城市。目前， 只有当患者的提供者看到患者时，才会发出筛查邀请。 因此，许多符合条件的个人，特别是45-55岁的人，不经常 获得医疗保健，都没有得到充分的筛查。因此，改善筛查的需求尚未得到满足。 练习。我们假设，患者护理(结直肠癌筛查率)将在以下方面有所改善： 通过实施积极主动的方法服务于人群，其中包括邮寄的 邀请外展人员进行筛查，然后积极协助完成结肠镜检查 包括克服财务和后勤方面的障碍。为了解决这一假设，我们试图 通过评估有效性和改进混合I型试验中的结直肠癌筛查 在多个联邦州实施积极主动的结直肠癌外展筛查计划 布鲁克林的合格健康中心(FQHC)，主要为黑人患者服务。这项建议 工作将为扩大长期、持续的规模提供关键的、基础的信息 在纽约市其他FQHC中实施筛查计划。我们建议执行一项 在五家FQHC进行主动邀请的随机试验，目的是研究 积极主动的外展计划，确定应进行筛查的人，邮寄粪便免疫化学物质 测试并为日常准备和运输费用提供导航和财务支持 关心提高CRCC筛查率，了解障碍和促进者积极主动 通过调查患者和提供者进行推广，并对该计划进行成本分析

Colorectal Cancer (CRC) is the third most common cancer in men and women and the second leading cause of cancer related death. Screening for CRC reduces CRC incidence and mortality, and is recommended for average risk men and women between the ages of 45 and 75 by the US Preventive Services Task Force guidelines; which were updated recently to include 45-49 year olds, an additional 20 million individuals in the US. In New York City screening rates are 78% in Manhattan but only 26-55% in federally qualified Health Centers (FQHC) across the city that provide free and subsidized health services to underrepresented minorities. Currently, invitations to screen are offered only when a patient is seen by his or her provider. Consequently, many eligible individuals, particularly 45-55 year olds who do not regularly access healthcare, are under-screened. Hence, there is an unmet need for improving screening practices. We hypothesize that patient care (rates of CRC screening) will improve in under- served populations with the implementation of a proactive approach that incorporates a mailed outreach invitation to screen, followed by active assistance to a colonoscopy completion including overcoming financial and logistical barriers. To address this hypothesis, we seek to improve CRC screening in a hybrid type I trial by assessing the effectiveness and implementation of a proactive outreach colorectal cancer screening program in multiple federally qualified health centers (FQHCs) in Brooklyn, serving primarily Black patients. This proposed work will provide critical, foundational information for scaling up long-term, sustained implementation of screening program across other FQHCs in NYC. We propose to perform a randomized trial of proactive invitation at five FQHCs with aims to study the effect of a proactive outreach program that identifies those due for screening, mail a fecal immunochemical test and provide navigation and financial support for cost of preparation and transport to usual care in improving CRCc screening rates, understand barriers and facilitators to proactive outreach by surveying patients and providers, and perform a cost analysis of the program