SummaryAs part of the Community Cancer Screening Program™, the Cancer Coalition of South Georgia employs trained professional health navigators from the local community who support community health centers in identifying those in need of colorectal cancer screening via colonoscopy, and facilitate access to screening and needed followup care at partner hospitals and gastroenterology practices. (The navigators also perform similar tasks for breast and cervical cancer screening by referring eligible patients to local public health departments for no-cost screening and followup services under the National Breast and Cervical Cancer Early Detection Program.) The program has enhanced access to colonoscopy referrals and screening for high-risk, uninsured individuals primarily in rural areas, leading to more cancers and precancerous polyps being detected and treated in a timely manner.Moderate: The evidence consists primarily of a comparison of referral and testing rates for colonoscopies among eligible adults in four community health center clinics that participated in the program to nine similar clinics that did not. Additional evidence includes comparisons of no-show and cancellation rates between program participants and private-pay patients, and comparisons of the proportion of program participants having precancerous polyps removed during a colonoscopy to national averages.
Developing OrganizationsCancer Coalition of South Georgia
Date First Implemented2006
Patient PopulationThe program serves uninsured individuals age 50 to 64 who are due for colorectal cancer screening; most of those served live in rural areas.Vulnerable Populations > Medically uninsured; Age > Middle-aged adult (45-64 years); Vulnerable Populations > Rural populations
Problem AddressedColorectal cancers (CRCs) are common and often deadly, but they frequently can be prevented or in some cases diagnosed and treated through a colonoscopy procedure. Despite recommendations that adults age 50 to 75 be screened through one of various methods (including colonoscopy), many eligible adults do not comply with these recommendations, particularly low-income racial and ethnic minorities who face multiple barriers to doing so.
- A common, deadly problem: CRCs represent the third most common and third deadliest form of cancer among both males and females in the United States and in Georgia.1 Incidence and death rates in rural southwest Georgia are higher than in the rest of the State.2,3
- Unrealized potential of screening through colonoscopy: The United States Preventive Services Task Force (USPSTF) recommends CRC screening through colonoscopy, flexible sigmoidoscopy, or fecal occult blood test for most adults age 50 to 75.4 Several professional organizations, including the American Cancer Society and American College of Gastroenterology, recommend colonoscopy as a preferred method of screening due to its greater sensitivity and its ability to detect and remove precancerous polyps.4,5 Yet in 2010, less than 60 percent of eligible adults had been screened according to USPSTF guidelines.6
- Additional barriers for low-income minorities: CRC screening rates remain especially low among minorities and low-income populations, including the uninsured and those in rural areas. In addition to not having adequate health insurance or access to a regular source of care, these individuals often face other barriers to accessing screening services, including logistical challenges (e.g., scheduling, transportation), cognitive–emotional barriers (e.g., fear and embarrassment related to the procedure), and educational barriers, including not being aware of risk factors and the importance of screening.7,8,9,10,11,12,13
Description of the Innovative ActivityAs part of the Community Cancer Screening Program™, the Cancer Coalition of South Georgia employs trained professional health navigators from the local community who support community health centers (CHCs) in identifying those in need of colonoscopy screening, and facilitate access to screening and needed followup care at partner hospitals and gastroenterology practices. (The navigators also perform similar tasks for breast and cervical cancer screening.) Key program elements are outlined below:
Figure 1. A health navigator and physician assistant reviewing a patient's chart. Click the image to enlarge. Image courtesy of Cancer Coalition of South Georgia. Used with permission.
- Trained health navigators from local community assigned to CHCs: Trained health navigators (see Figure 1) who live in the local community work out of nine CHCs (operated by three federally qualified health centers), a rural health center, a private primary care practice, and a medical residency program. These facilities serve patients from 30 of the 32 counties in the coalition’s service area (South Georgia), with the vast majority of patients coming from 24 of these counties. Each navigator generally takes responsibility for working with two or three clinic sites.
- Chart-based identification of patients due for screening: At each center, the navigator reviews the medical charts of patients scheduled for a visit the following week who are in the target age range (50 to 64) for CRC screening. (Navigators perform similar tasks to identify women in need of breast and cervical cancer screening.) When the program first launched, participating centers generally had paper records, but now all but three of the centers have electronic medical records (EMRs).
- Visible prompt placed in record to encourage referrals: The navigator creates an easy-to-see prompt within the medical record to remind the provider to discuss the need for screening at the upcoming visit. With paper-based records, the navigator places a preprinted list with checkboxes to denote needed screening tests (colonoscopy, mammogram, Pap smear). With EMRs, providers generally see an electronically generated “sticky note” on the patient's medical history screen that reminds them to check for needed cancer screenings. After seeing the sticky note, the physician clicks on a folder to search for information on past screening and hence determine if a referral is in order.
- Referrals and medical clearance: For anyone deemed due for screening, the referral typically occurs during the visit, although in some cases it may not occur until after the fact, as outlined below:
- During-visit referrals: In most cases, the physician discusses the need for a colonoscopy and provides the referral during the visit. In these instances, the physician also evaluates and clears the patient medically to undergo the procedure, thus avoiding the need for a separate visit to a gastroenterologist for clearance. (The gastroenterology practices and hospitals that provide colonoscopies as part of this program have approved this approach.)
- Post-visit referrals: Each week, the navigator reviews the cases of all patients flagged in the prior week to make sure that needed referrals were in fact made. If not (e.g., due to an oversight or time constraints), the navigator checks with the relevant physician to get approval to contact the patient about scheduling the test. In some cases, a referral may not have been made because the patient indicates that he or she has received screening that does not show up in the medical record. In these instances, the navigator checks with the site to confirm the screening and obtains a copy of the record. As appropriate, the navigator either places the record in the patient’s paper-based chart or scans it into the patient’s record within the EMR system.
- Initial intake visit or call: If the navigator is in the clinic at the time the visit occurs, he or she usually attempts to meet the referred patient. If not (or if the patient cannot meet at that time), the navigator calls the patient later that day or the next day to conduct an intake visit by phone. During this roughly 15-minute conversation, the navigator collects additional information on the patient’s medical history (e.g., more information on risk factors, such as past cancers, family history of cancer) and financial situation (to verify that the individual is not eligible for insurance coverage through an existing program such as Medicaid). As part of this call, the navigator also briefly explains the colonoscopy procedure and the process going forward. The navigator asks the patient about preferences as to when and where the procedure should be scheduled, and whether the patient will need assistance with transportation. (Patients cannot drive themselves home after a colonoscopy procedure.)
- Procedure scheduling: The navigator calls to schedule the appointment at one of the coalition’s partner facilities, typically the facility closest to the patient’s home. Partner facilities include the Phoebe Putney Memorial Hospital (which offers colonoscopy procedures at an outpatient endoscopy center and in the hospital), the Tift Regional Medical Center and its affiliated Affinity Clinic endoscopy center, and the Miller County Hospital (a 25-bed critical access hospital).
- Culturally tailored education and logistical support to prepare for procedure: Once the procedure has been scheduled, the navigator calls the patient on a regular basis to provide culturally appropriate education and support to help in preparing for the procedure. The navigator also provides his or her cell phone number and urges the patient to call if questions or concerns arise. Key components of this education and support are outlined below:
- Appointment confirmation and educational packet: After scheduling the appointment, the navigator calls the patient to provide relevant details, including date, time, and place. The navigator again educates the patient about CRC and cancer screening and again inquires about any potential barriers, including fear of the procedure, difficulties in accessing materials needed to prepare for it (e.g., access to a bathroom and appropriate liquids to allow adherence to the preprocedure diet), and transportation-related issues. After the call, the navigator prepares and mails a packet of information, including written confirmation of the appointment details and easy-to-understand, culturally tailored educational materials about CRC and colonoscopy written specifically for a low-income population with low levels of health literacy.
- Reminder call to review preparation instructions: Roughly a week before the procedure, the navigator calls the patient to review the instructions related to preparing for the procedure, including bowel preparation and diet. During this approximately 20-minute call, the navigator has the patient place the various bottles and instructions on a table in order to ensure that he or she knows what they are and how to mix and drink the preparation. The navigator confirms that the patient has appropriate liquids available to adhere to the diet and arranges to have clear broth delivered if necessary. The navigator also confirms that the patient will have access to a bathroom with toilet paper and helps to arrange for such access if not. For example, the navigator arranged for one patient whose home did not have indoor plumbing to use a relative’s bathroom during the preparation process. Finally, the navigator confirms that the patient has transportation to and from the appointment, arranging for such transportation with a local company if necessary. (Most rural areas of South Georgia do not have public transportation.)
- Reminder call about diet: The navigator calls the day the patient is supposed to begin a liquid diet, making sure that he or she understands and follows all dietary instructions.
- Check-in call: The navigator calls the patient the night before the procedure to see how the bowel preparation process is proceeding, providing guidance and support as necessary.
- Provision of colonoscopy at no cost to patient: Partnering gastroenterology practices and hospitals provide colonoscopy procedures at no cost to the patient. The partner hospitals and endoscopy centers waive their facility fees for all procedures. Professional fees for colonoscopy and pathology services are either donated or offered to the Cancer Coalition at reduced rates.
- Timely communication of results: After the procedure, the navigator makes sure that the test results get to the clinic-based physicians within 48 hours, thus ensuring the clinic can communicate them to the patient in a timely manner. If necessary, the navigator contacts the medical records office at the facility where the procedure was performed to obtain the record and, as appropriate, puts the results in the patient’s paper record or scans the results into the clinic’s EMR system.
- Followup scheduling and support: If no further care is required, the navigator enters information into the medical record about the appropriate timing for the next screening, which could be anywhere from 1 year to 10 years depending on the presence (and type) of any polyps found during the procedure. (Patients with a “clean” colonoscopy typically get rescreened in 10 years, while those with high-risk or precancerous polyps may need followup screening more frequently.) Navigators also support patients who face any ongoing administrative issues or problems, such as a facility or physician inadvertently sending a bill for the procedure. If a patient needs additional care (e.g., resection, cancer treatment, additional tests), the navigator schedules and facilitates access to that followup care and provides needed education and support throughout the process.
- Periodic performance reports for clinics: The navigators provide data to the program manager on a weekly basis that detail the number of referrals and screening procedures completed. The program manager prepares and distributes a monthly report to each participating CHC, detailing referral and screening rates for the clinic as a whole and for individual physicians. Each site gets only its own data, with no comparisons to other participating centers.
Context of the InnovationThe Cancer Coalition of South Georgia formed in 2002 as a nonprofit organization dedicated to preventing cancer and increasing cancer survival rates in a 32-county, predominantly rural region of south Georgia that is home to 700,000 residents, many of whom are low-income racial and ethnic minorities without health insurance or access to a regular source of care. The Cancer Coalition formed in response to data showing a significant gap in screening and high cancer mortality rates in the local community.
James Hotz, MD, a local physician who practiced in the area for many decades, spearheaded the effort by convincing leaders of local community cancer centers, public health agencies, hospitals, physician groups, universities, businesses, civic organizations, and religious organizations to come together to tackle these issues. Hospitals and affiliated gastroenterology practices agreed to participate in the program after realizing that many uninsured patients were coming to the emergency department (ED) with late-stage colorectal cancer that proved difficult and costly to treat.
ResultsThe program has enhanced access to colonoscopy referrals and screening for high-risk uninsured individuals who live primarily in rural areas, leading to the detection and timely treatment of more cancers and precancerous polyps.
Moderate: The evidence consists primarily of a comparison of referral and testing rates for colonoscopies among eligible adults in four community health center clinics that participated in the program to nine similar clinics that did not. Additional evidence includes comparisons of no-show and cancellation rates between program participants and private-pay patients, and comparisons of the proportion of program participants having precancerous polyps removed during a colonoscopy to national averages.
- Enhanced access to screening: Each year, more than 500 individuals receive colonoscopy screening through the program. Many of these individuals would not have been screened in the absence of the program, as suggested by the evidence below:
- Higher referral rates: During an 18-month period (November 1, 2009, to April 30, 2011), 58 percent of eligible adults received a referral for a colonoscopy examination in four CHCs that participated in the program, compared to 24 percent of eligible patients in nine CHCs that did not. After adjusting the data for age, race, and other factors, researchers calculated that a patient eligible for CRC screening who came to a participating CHC had a 4.8 times greater likelihood of being referred than if seen in a control-group clinic. (Routinely used by statisticians, this figure is commonly referred to as an “odds ratio.”) In a separate analysis of CHCs with EMRs, there was no statistically significant difference in referral rates between participating and nonparticipating CHCs. This finding suggests that EMRs may have a positive impact on cancer screening referrals (something that other studies have concluded as well), and hence may reduce the impact of navigators on this particular aspect of the program.14
- Very few no-shows and cancellations: Less than 3 percent of patients fail to show up for their procedure, a no-show rate in line with that for insured patients seen in private practices. Prior to implementation of this program, no-show rates in the target population approached 50 percent. In addition, less than 5 percent of patients cannot undergo the procedure because they failed to comply with bowel preparation procedures, a rate similar to that seen in private-pay patients.
- Higher screening rates: Approximately 35 percent of eligible patients seen in the participating centers underwent a colonoscopy examination, compared to 7 percent of those in the control-group clinics. After adjusting the data for age, race, and other factors, researchers concluded that an eligible patient seen in a participating clinic was 7.9 times more likely to receive a colonoscopy than if seen in a control-group clinic.14
- Greater adherence to guidelines: Overall, 43 percent of patients treated in participating CHCs were compliant with established American Cancer Society guidelines at the end of the study period, compared to 11 percent of those treated in control-group sites. After adjusting the data for age, race, and other factors, researchers concluded that an eligible patient seen in a participating clinic was 5.9 times more likely to be in compliance with guidelines than if cared for in a control-group site.14
- Better detection, removal of precancerous polyps and early-stage cancers: On average, one or two individuals (out of roughly 500) screened through the program each year end up being diagnosed with CRC, usually at an early stage. In addition, roughly 35 percent of those screened have adenomas (benign tumors that often become cancerous) removed, above the national average of 20 to 25 percent. This difference suggests the program has been effective in preventing CRC in those at disproportionate risk.
Planning and Development ProcessKey steps included the following:
- Forming coalition: Over a period of several years, Dr. Hotz formed a “coalition of the willing,” approaching various stakeholders to explain the need for increased screening rates and to gauge their interest in participating. His goal was to bring together a large number of stakeholders, asking each to do a small part in addressing the issue without overwhelming any individual or organization. To that end, he met with all the key players needed to provide screening for CRC and the other targeted cancers, including hospitals, gastroenterologists, pathologists, radiologists, oncologists, surgeons (for back-up), and others. These stakeholders were familiar with the concept of a community-based coalition, as the area was also home to the first rural HIV program in the country that also involved coalition building. During these discussions, Dr. Hotz forged agreements with providers to either donate their services or provide them for a reduced fee.
- Conducting plan–do–study–act (PDSA) cycles: With support from local medical school students, the Cancer Coalition conducted a series of PDSA cycles to evaluate the various challenges related to improving screening rates, including how to identify eligible patients, promote referrals, and facilitate access to services.
- Developing program, including decision to hire navigators: Using knowledge gleaned from the PDSA cycles, Cancer Coalition leaders developed the CRC screening program by adapting recommendations of the Task Force on Community Preventive Services, which advocates several interventions that have been shown to be effective in increasing CRC screening through fecal occult blood tests. These interventions include one-on-one education, client reminders, elimination of structural barriers to screening, provider assessment and feedback, and provider reminders and recall.15,16 The leaders adapted these initiatives to screening via colonoscopy. As part of this effort, they concluded that navigators should play a key role in identifying and supporting patients and in working with providers.
- Conducting and evaluating one-county pilot test: In 2006, the Cancer Coalition pilot tested the program in Baker County, home to about 4,000 residents at the time. The program operated in partnership with one federally qualified health center, the local public health department, a local hospital, a pathology group, and a general surgeon who performed the colonoscopy procedures. As part of the study, these partners agreed to provide free CRC, breast, cervical, and prostate screening to uninsured county residents. The Cancer Coalition hired a retired nurse on a part-time basis to serve as the navigator.
- Partnering for program evaluation: The Cancer Coalition partnered with the Emory Prevention Research Center to analyze the pilot program. This 2007 evaluation focused primarily on the program’s strengths and weaknesses, providing recommendations on how best to replicate it in other South Georgia counties. (More information on how the program spread after the Baker County pilot can be found in the Spreading This Innovation section.) The Emory Prevention Research Center also conducted the previously described analysis of the broader program, comparing referral and screening rates in four CHCs that participated to nine that did not.
- Hiring and training navigators for broader program: Phoebe Putney Hospital’s human resources department hires navigators on behalf of the coalition. The department generally looks for individuals with substantial experience working as case managers for low-income, uninsured families in community settings. Newly hired navigators complete a comprehensive 2-week training program in which they learn about cancer (e.g., how it forms, why it spreads, why early detection matters) and how to communicate with patients in need of screening. They also learn how to perform various job-related activities, such as finding past screening information in the medical record system and generating prompts for those in need of referrals. Navigators also complete hospital- and CHC-based training on Health Insurance Portability and Accountability Act requirements. After completing in-house training, they spend 2 to 4 weeks receiving on-the-job training under the supervision of a manager, first observing others as they work with patients and subsequently working with patients under the watchful eye of the manager. This process continues until the manager concludes they are ready to work independently with patients in a clinical setting.
Resources Used and Skills Needed
- Staffing: The program has 4.5 full-time equivalent navigators who identify and support patients potentially in need of CRC, breast, and cervical cancer screening. Each full-time navigator generally covers two clinic sites, working with 20 to 25 patients a month. In addition, the program has a full-time manager who spends a small amount of her time providing patient navigation services and a senior administrator who spends roughly 10 to 15 percent of her time on quality control, partnership development and maintenance, contract management, and program evaluation. The organization's chief executive officer spends about 3 to 5 percent of her time sustaining the program by maintaining in-kind support and operational funding.
- Costs: Annual program costs total roughly $200,000, which covers navigation services for patients in need of breast, cervical, and CRC screening, along with payments to partners providing colonoscopy procedures. Program partners contribute an additional $300,000 in in-kind contributions related to the CRC screening component of the program.
Funding SourcesCenters for Disease Control and Prevention; Cancer Coalition of South Georgia; Georgia Department of Public Health
As noted earlier, the partner hospitals, endoscopy centers, and gastroenterologists support the program by offering reduced fees and in some cases waiving professional and facility fees for eligible patients. CHCs and other primary care partners provide free office space to the navigators.
Emory Prevention Research Center's evaluations of this program were supported by the Centers for Disease Control and Prevention and the National Cancer Institute.
Tools and Other ResourcesMore information about this program can be found at http://www.sgacancer.org. Additional resources related to CRC screening include the following:
Getting Started with This Innovation
- Identify physician champion and organization to lead coalition building: A passionate, respected physician champion can clearly articulate the problem and convince the leaders of various stakeholder organizations to do their part in addressing it. Key stakeholders include primary care physicians, gastroenterologists, oncologists, surgeons, endoscopy centers, hospitals, pathologists, radiologists, and anesthesiologists. In addition, some entity must be responsible for coalition building. In areas without a local or regional cancer coalition, another independent organization needs to take charge of bringing together stakeholders that normally compete with each other.
- Share data on burden caused by inadequate screening: As part of the coalition-building effort, it is important to share data that document the problem of low cancer-screening rates in the local area. Discussions should emphasize the financial and human burden that such low screening rates create, including evidence that many uninsured patients present to the ED with late-stage cancers that are expensive and difficult to treat. Data on ED visits may be particularly useful when speaking with hospital and ED leaders faced with overcrowding issues.
- Document provider agreements in writing: The use of written contracts for provider agreements can eliminate misunderstandings or unexpected changes to the agreed-upon terms. Contracts can be used to reinforce the need for participating providers to adhere to established guidelines when referring patients for screening.
- Hire and train navigators from local community: Navigators from the local community generally have backgrounds and life experiences similar to those of the patients they are serving and hence are better able to build trusting relationships with them. They can also provide culturally competent and sensitive services to the target population. Once hired, navigators should undergo an extensive training process before working independently with patients.
Sustaining This Innovation
- Encourage clinics to educate staff on referral policy: Participating clinics should adopt a clear policy with respect to referring patients for screening and should educate existing and new staff about this policy on a regular basis. (Many clinics have high staff turnover.) This step empowers any member of the staff to intervene when an eligible patient does not receive a referral. For example, as a patient checks out after a visit, front-desk staff may notice that the physician, nurse, or physician assistant forgot to provide a needed referral. In these instances, staff can quickly check with the relevant clinician to verify that the omission was an oversight and, if so, can provide the referral before the patient leaves.
- Regularly share data with stakeholders: The various provider organizations involved in the program will be much more likely to remain enthusiastic and supportive if they regularly see data documenting its benefits, including the high percentage of those screened who end up having precancerous polyps or early-stage cancers removed. (Leaders of the Cancer Coalition of South Georgia share such information with hospital leadership on a quarterly basis.) Cancer center leaders will be particularly interested in data that help them maintain their accreditation by the American College of Surgeon's Commission on Cancer, while administrators of not-for-profit hospitals will be interested in data that help them meet community benefit requirements and hence maintain tax-exempt status.
- Maintain adequate provider capacity: The program will not succeed unless enough providers (particularly gastroenterologists) are available to provide free or reduced-cost services. The goal should be to provide patients with timely care without overburdening any one provider. Rather, each partner should do his or her small part, sharing the extra (largely uncompensated) work of providing screening services to uninsured individuals. Ideally, providers should be able to handle any additional cases as part of their regular schedule, without the need for evening or weekend hours.
- Consider high-sensitivity blood tests as first-line screening: In areas with limited provider capacity, consideration can be given to use of high-sensitivity fecal occult blood tests or the fecal immunochemical test (more commonly known as FIT) as an alternative to colonoscopy. Only those testing positive on the initial test (roughly 5 percent of patients nationally) will then require colonoscopy. The Cancer Coalition is currently pilot testing FIT as an option with one of its clinical partners.
- Continually seek new funding sources, including in-kind contributions: This program serves uninsured individuals and hence depends on the willingness of various funders and stakeholder organizations to provide financial or in-kind donations. To elicit such support, program leaders should reach out to potential supporters on a regular basis, sharing information that documents the need for higher screening rates in disadvantaged populations and the benefits of achieving higher rates.
- Assist eligible patients in securing Medicaid coverage: In States that are expanding Medicaid eligibility under the Affordable Care Act, previously uninsured patients served by the program may become eligible for coverage.
- Lobby public and private payers to cover navigation services: Public and private payers at the local, regional, and national level may be willing to pay for navigation services once they better understand the benefits that they generate. As medical homes become more prominent, payers may be receptive to the idea of building in payments to cover navigation services.
Spreading This InnovationAs noted, the program began in one county and subsequently spread to other areas, as detailed below:
- Coalition-led expansion across south Georgia: After the 2007 evaluation of the pilot screening program in one south Georgia community, the Cancer Coalition expanded the initiative into a regional partnership that spanned 30 counties in south Georgia, 24 of which are home to the majority of those served.
- Adoption of navigator model across State, including by other regional coalitions: In a proposal for funding from the Centers for Disease Control and Prevention, the Division of Cancer Control within the Georgia Department of Public Health identified the use of navigators as a model to be replicated across the State. After receiving the grant funding, the State contracted with the Cancer Coalition of South Georgia to provide technical assistance and training to other stakeholders implementing the navigator model. To date, two of the four other regional cancer coalitions in Georgia are using navigators to conduct education and outreach related to cancer screening, with a focus on promoting use of FIT rather than colonoscopy for CRC screening.
- Consideration as national model: Based on an analysis of this program and similar initiatives elsewhere, the National Colorectal Roundtable has concluded that navigators are critical to increasing CRC screening rates and hence plans to promote their use throughout the country.
Contact the InnovatorDenise Ballard
Cancer Prevention and Control
Cancer Coalition of South Georgia, Inc.
2332 Lake Park Drive
Albany, GA 31707
James Hotz, MD
Cancer Prevention and Control
Cancer Coalition of South Georgia, Inc
2332 Lake Park Drive
Albany, GA 31707
Chief Executive Officer
Cancer Coalition of South Georgia, Inc.
2332 Lake Park Drive
Albany, GA 31707
Innovator DisclosuresMs. Ballard and Ms. Fletcher reported that the Cancer Coalition of South Georgia received grant funding and travel support from the Georgia Department of Public Health, the Georgia Research Alliance, and the Georgia Cancer Coalition. This funding came in turn from State tobacco settlement funds and a Centers for Disease Control and Prevention Colorectal Cancer Program grant.
Dr. Hotz reported being on the steering committee of the National Colorectal Cancer Roundtable and the steering committee of the Georgia State Cancer Plan.
Ms. Fletcher reported being compensated as the chief executive officer of the Cancer Coalition of South Georgia and being an ex officio member of its board of directors.
RecognitionThe Community Cancer Screening Program™ was one of three organizations to receive the Mutual of America Foundation 2013 Community Partnership Award. This award, which includes national recognition from the foundation and a $25,000 grant, honors community-based partnerships that stimulate adoption of new approaches for addressing significant social issues.
Georgia Division of Public Health. OASIS–Online Analytical Statistical Information System. Page version 3.0. Available at: http://oasis.state.ga.us/
Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104(3):739-50. [PubMed]
Centers for Disease Control and Prevention (CDC). Cancer screening–United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(3):41-5. [PubMed]
Robinson CM, Cassells AN, Greene MA, et al. Barriers to colorectal cancer screening among publicly insured urban women: no knowledge of tests and no clinician recommendation. J Natl Med Assoc. 2011;103(8):746-53. [PubMed]
Robinson JM, Shavers V. The role of health insurance coverage in cancer screening utilization. J Health Care Poor Underserved. 2008;19(3):842-56. [PubMed]
Griffith KA, Passmore SR, Smith D, et al. African Americans with a family history of colorectal cancer: barriers and facilitators to screening. Oncol Nurs Forum. 2012;39(3):299-306. [PubMed]
Denberg TD, Melhado TV, Coombes JM, et al. Predictors of nonadherence to screening colonoscopy. J Gen Intern Med. 2005;20(11):989-95. [PubMed]
Green AR, Peters-Lewis A, Percac-Lima S, et al. Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. J Gen Intern Med. 2008;23(6):834-40. [PubMed]
Gimeno Garcia AZ. Factors influencing colorectal cancer screening participation. Gastroenterol Res Pract. 2012;2012:483417. [PubMed]
McAlearney AS, Reeves KW, Dickinson SL, et al. Racial differences in colorectal cancer screening practices and knowledge within a low-income population. Cancer. 2008;112(2):391-8. [PubMed]
Honeycutt S, Green R, Ballard D, et al. Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA. Cancer. 2013;119(16):3059-66. [PubMed]
Sabatino SA, Lawrence B, Elder R, et al. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am J Prev Med. 2012;43(1):97-118. [PubMed]
Community Preventive Services Task Force. Updated recommendations for client- and provider-oriented interventions
to increase breast, cervical, and colorectal cancer screening. Am J Prev Med. 2012;43(1):92-6. [PubMed]
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Original publication: May 07, 2014.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: May 07, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.