University Of North Carolina At Chapel Hill receives $607K Cancer Cause and Prevention Research grant from the National Institutes of Health

Enhancing cervical cancer screening through integrated care in rural North Carolina - abstract cervical cancer is a preventable chronic disease, yet approximately 4,000 women, disproportionately rural and underinsured, in the united states die of cervical cancer each year. In North Carolina (nc), cervical cancer incidence and mortality is approximately 30% higher in rural counties than in urban counties. Food insecurity, housing instability, and transportation difficulties are prevalent in rural areas and compound health disparities. This proposal aims to implement and assess the effectiveness of a health information technology (it)-driven integrated care intervention, community compass, to improve cervical cancer screening rates, community resource utilization, preventive care, and healthcare management in rural eastern nc. We will leverage health it to (a) generate integrated care plans, (b) provide longitudinal support to address participants' integrated (medical, social, and wellness) needs, and (c) systematically document and track provision of integrated needs care, follow-up screenings, and engagement with other age-appropriate preventative care. Community compass comprises of three components delivered by clinic navigators to patients: (a) education about cervical cancer, screening, and related behavioral risk factors (e.g., smoking, multiple partners, parity), (b) a care plan that includes information about cervical cancer and other age-appropriate cancer screening options as well as electronic health record-based integrated care referrals to community resources (e.g., food pantry, transportation, smoking cessation), and (c) long-term navigation support to promote initiation of, and sustained engagement with, follow up care. Our study site, goshen medical center, is a federally qualified health center with 38 community clinics in rural, eastern nc. Our community-engaged and multidisciplinary research team will leverage our infrastructural intervention and implementation science expertise to test the effects of community compass through three related aims. Aim 1 will assess contextual implementation factors (feasibility, organizational readiness, and networks) that influence the community compass-embedded clinical workflow. We will conduct three plan-do-study-act cycles with clinicians and medical staff (n=12-15) at two clinics. Aim 2 will employ a pragmatic randomized controlled trial recruiting 468 cervical cancer screening- eligible women aged 25-65 years, randomized across three arms. Secondary outcomes include abnormal screening follow-up; uptake of other age-appropriate cancer screenings; markers of allostatic load; and community resource knowledge, utilization, and sharing. In aim 3, we will conduct a trial-based cost- consequence analysis to inform the sustainability and scaling of community compass to other rural-based primary care and cancer centers in nc.