Publication date: Sep 15, 2024

Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity. A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant. Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11. 5 percentage points (ppts) (95% CI, 6. 1-16. 9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12. 6 ppts [95% CI, 7. 2-18. 0 ppts] for females; 8. 8 ppts [95% CI, 4. 7-13. 9 ppts] for males) and by racial and ethnic group (13. 8 ppts [95% CI, 7. 0-20. 6 ppts] for Hispanic individuals; 13. 0 ppts [95% CI, 3. 6-22. 4 ppts] for Asian individuals; 11. 3 ppts [95% CI, 5. 8-16. 8 ppts] for non-Hispanic White individuals; 6. 1 ppts [95% CI, 0. 8-10. 4 ppts] for Black individuals). A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations.

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