Community Collaboration to Advance Racial/Ethnic Equity in CRC Screening

This is a 3-year pragmatic trial with four levels of intervention, including system-, provider-, patient-, and community-level components at each of the CARES clinical sites. Health system components will include the development and implementation of a CRC screening registry and tracking database to systematically and actively track patients overdue for screening, screening test completion, and abnormal screening results. Data systems will be coupled with process re-design to improve clinical workflow for screening outreach. Providers will receive educational support through a training session about the importance of CRC screening, screening test options, population management, and an instructional on how to complete a Cologuard kit (Cologuard arm only) or a FIT kit (FIT arm only). Patient components of the intervention vary by study arm. In sites randomized to Cologuard, patients will receive a mailed Cologuard kit and the Exact Sciences patient support program. Patients in clinics randomized to FIT will receive a mailed FIT kit with systematic reminders. Patients who test positive will be offered patient navigation to assist with completing a diagnostic colonoscopy.

Inclusion criteria

• Age 45-75
• Has had a visit at a participating community clinic within the last two years.
• Alive
• Patient's preferred language is English or Spanish

Exclusion criteria

Exclusion criteria

• Has Ulcerative Colitis or Crohn's disease documented in the problem list. (Codes below).
• Has colorectal cancer documented in the problem list. (Codes below).
• Has had a FIT in the past 1 year
• Has had a colonoscopy in the past 10 years

ICD-10 codes for exclusion criteria:

Ulcerative colitis:

• K51.0
• K51.2
• K51.3
• K51.4
• K51.5
• K51.8
• K51.9
• K52.8
• K52.9

Crohn's disease:

• K50.0
• K50.1
• K50.8
• K50.9

Colorectal cancer

• C18 (malignant neoplasm of colon)
• C18.0 (malignant neoplasm of cecum)
• C18.1 (malignant neoplasm of appendix)
• C18.2 (malignant neoplasm of ascending colon)
• C18.3 (malignant neoplasm of hepatic flexure)
• C18.4 (malignant neoplasm of transverse colon)
• C18.5 (malignant neoplasm of splenic flexure)
• C18.6 (malignant neoplasm of descending colon)
• C18.7 (malignant neoplasm of sigmoid colon)
• C18.8 (malignant neoplasm of overlapping sites of colon)
• C18.9 (malignant neoplasm of colon, unspecified)
• C19 (malignant neoplasm of rectosigmoid junction)
• C20 (malignant neoplasm of rectum)
• C21.8 (malignant neoplasm of overlapping sites of rectum, anus and anal canal)
• C26.0 (malignant neoplasm of intestinal tract, part unspecified)
• C78.5 (secondary malignant neoplasm of large intestine and rectum)
• C78.6 (secondary malignant neoplasm of retroperitoneum and peritoneum)
• D37.4 (neoplasm of uncertain behavior of colon)
• D37.5 (neoplasm of uncertain behavior of rectum)