Screening More Patients for Colorectal Cancer Through Adapting and Refining Targeted Evidence-Based Interventions in Rural Settings, SMARTER CRC

Last updated: December 4, 2024
Sponsor: OHSU Knight Cancer Institute
Overall Status: Completed

Phase

N/A

Condition

Colorectal Cancer

Carcinoma

Cancer/tumors

Treatment

Patient Navigation

Fecal Immunochemical Test

Interview

Clinical Study ID

NCT04890054
STUDY00020681
UH3CA244298
STUDY00020681
NCI-2021-01032
  • Ages > 18
  • All Genders
  • Accepts Healthy Volunteers

Study Summary

This study collects information to provide a model for how to rapidly adapt and scale-up multilevel interventions through clinic-health plan partnerships to reduce the burden of colorectal cancer (CRC) on the United states population. This study may improve colorectal cancer screening rates, follow-up colonoscopy, and referral to care in rural Medicaid patients.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • CCOs/CCO STAFF: Serving a majority of counties that are predominantly rural based on 2010 Rural-Urban Commuting Area (RUCA) codes (codes 4-10)

  • CCOs/CCO STAFF: Willing to participate in data collection activities (e.g.,producing claims data, interviews)

  • CLINICS: Clinics will be eligible for the cluster randomization if there are 30 ormore patients eligible for screening

  • CLINICS: Are classified as rural according to RUCA (Codes 4-10) or Oregon Office ofRural Health designations

  • CLINICS: Are served by CCOs agreeing to participate in the project

  • CLINICS: Willing to implement the intervention into their clinic for the study

  • CLINIC STAFF/PROVIDERS: Employed as a clinician or ancillary staff member in aparticipating clinic

  • CLINIC STAFF/PROVIDERS: Willing to participate in data collection activities (e.g.,interviews, observation, surveys)

  • PATIENTS: Attributed to participating clinic

  • PATIENTS: Are enrolled in Medicaid or dual eligible

  • PATIENTS: Eligible for colorectal cancer (CRC) screening

  • PATIENTS: For the subset of patients that will be invited to participate in keyinformant interviews, a 5th eligibility criteria is consented to participate

  • COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: (Includes endoscopy providers,community-based outreach workers, or leaders from regional or national organizationswho participate in the pilot, pragmatic trial, or scale-up study)

  • COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: Involved in study activities (training, care delivery)

  • COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: Willing to participate in datacollection activities (e.g., trainings, interviews, surveys)

  • Elderly - Yes - we anticipate that a limited number of clinic and CCO staff, orcommunity organization representatives may be elderly; we limit our patientrecruitment to those aged 45-75

  • Rural - Yes

  • Inner city - No

  • Low income - Yes

  • Disabled - Yes

  • Chronic care - Yes

  • End of life - Yes - This is possible, but we predict limited numbers because of thetypes of individuals we are recruiting: clinic and CCO staff, and patients who arenot currently in hospice care

  • Minorities - Yes

Exclusion

Exclusion Criteria:

  • CLINICS: Clinics are excluded if they have current or ongoing participating in othermailed fecal testing research projects in the Medicaid population

  • PATIENTS: Are current for screening

  • PATIENTS: Comorbid conditions that make patients poor candidates for screening basedon clinical judgment (e.g., end-stage renal disease, enrollment in hospice)

  • PATIENTS: Are not an established patient or for other reasons documented by theclinics

  • All patients that we recruit will be at least 45 years of age or older

Study Design

Total Participants: 15510
Treatment Group(s): 3
Primary Treatment: Patient Navigation
Phase:
Study Start date:
May 14, 2021
Estimated Completion Date:
July 01, 2024

Study Description

PRIMARY OBJECTIVE:

I. Adapt, pilot, then test the implementation and scale-up of targeted direct mail and patient navigation programs.

OUTLINE:

This is an implementation-effectiveness trial of direct mail outreach and patient navigation intervention to improve rates of CRC screening. Eligible patients will be mailed a fecal immunochemical test (FIT). The mailed FIT and patient navigation interventions are a part of standard care and are carried out by the Medicaid health plan or clinic. Outcomes are tracked using reports from direct mail vendors, claims data from participating Medicaid health plans, clinic data from the electronic health record, chart review, and data from a REDCap database. The hypotheses will be tested using a two-arm cluster randomized trial design. Participating clinics will be randomized into two groups: Intervention and Usual Care. Medicaid health plans/ Coordinated care organizations (CCO) and clinic leadership participate in interviews and complete surveys.

The primary effectiveness outcome of this study is CRC screening likelihood in eligible Medicaid patients in intervention and control clinics at 6 months. Data will be collected at 6 time points: baseline, 6-months, 12-months, 18-months, 24-months, and 36-months.

Implementation outcomes and adaptations will be evaluated through interviews with clinic staff, patients, and CCO partners. Clinic staff in various roles related to the program (e.g., outreach workers, patient navigators, quality improvement leads) complete surveys and participate in interviews and observations at baseline, 6-9 months (post-implementation) and at approximately 12 months later, to assess clinic/health system level factors that may influence outcomes. Patients participate in interviews to explore patient experiences with the program. Regional and Organizational partners: CCO leaders, endoscopy providers (e.g., gastrointestinal specialists, general surgeons, primary care clinicians), and community organizations also participate in interviews.

Connect with a study center

  • OHSU Knight Cancer Institute

    Portland, Oregon 97239
    United States

    Site Not Available

Not the study for you?

Let us help you find the best match. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.