Gloria Coronado, PhD is an epidemiologist and the Mitch Greenlick Endowed Senior Investigator in Health Disparities at Kaiser Permanente Center for Health Research. She completed in training at Stanford University and the University of Washington. Dr. Coronado’s research has focused on understanding and addressing disparities in the occurrence and burden of disease in underserved populations, with a special emphasis on the Latino population in the Pacific Northwest. She has developed several innovative and cost-effective interventions to improve rates of participation in cancer screening among Latinos. She co-directs the STOP CRC program, a program that uses systems-based approaches to raise the rates of colorectal cancer screening in federally sponsored health centers in Washington, Oregon and California.
Questions and Answers
What aspects of the program can be adapted without it losing its effectiveness? Are there specific audiences (beyond those included in the research study) that you feel this program could be adapted for? Any that it shouldn’t be adapted for?
Since " El Proyecto de Salud Colorectal, The Colorectal Health Project” was conducted, several other studies evaluated direct-mail fecal testing programs. Direct mail programs were evaluated in integrated care settings, such as Group Health Cooperative (Dr. Beverly Green) and Kaiser Permanente Northwest (Dr. Adrienne Feldstein). A currently-funded, STOP CRC project (co-PIs: Coronado and Green) is testing a direct-mail program in multiple federally qualified health centers in Oregon and California. There is now sufficient evidence to suggest that direct mail programs can successfully improve rates of colon cancer screening in a variety of health care settings. We are still exploring how direct-mail programs can be adapted to maximize effectiveness. These efforts involve testing automated and live reminders to mailed fecal tests, using incentives, and matching test and reminders with patient choice.
What do you view as the facilitators to implementation? What might be some challenges?
A strong clinical champion is hands down the most important facilitator. A good team, that is willing to troubleshoot on-going issues is also key. These issue range from postage costs to results reporting from outside labs to updating medical records with historical colonoscopy in order to accurately identify patients who are due for screening.
Do you have suggestions for questions that practitioners should include when they evaluate the adaptation/implementation of your program? Do you have specific evaluation tools that would be appropriate for practitioners when they evaluate this program
When the program is evaluated, it is important to recognize that colon cancer screening that begins with fecal testing is a two-step screening process. Tracking the proportion of patients who screen positive on fecal testing and who receive a follow-up colonoscopy is critical to assuring that your fecal testing program can achieve the result of reduced mortality from colon cancer. In our data, we were surprised to find that Spanish-speakers had a higher FIT return rate than English-speakers. Thus, understanding return rates in population subgroups can help you design the best program for your patients.
What is your current research focused on?
My current research is focused on testing direct-mail programs in diverse federally qualified health centers. Future research will design effective strategies for prompting colonoscopy follow-up among patients who screen positive on fecal testing.