title: Colon cancer screening for Colorado's underserved: a community clinic/academic partnership.
abstract: BACKGROUND
  Colorectal cancer (CRC) is largely preventable by finding and removing adenomas, but many people have not been screened, especially the uninsured with low income.
  
  
  OBJECTIVE
  To establish a statewide infrastructure to ensure that low-income Coloradans receive colonoscopy for CRC screening and diagnostic evaluation.
  
  
  METHODS
  In 2006, a statewide program to provide free colonoscopy to uninsured Coloradans was developed as a partnership between the University of Colorado Cancer Center and Colorado safety-net clinics. Funded by excise tax revenues, the Colorado Colorectal Screening Program (CCSP) successfully embedded screening into primary care, providing patient navigation support and reimbursement that allowed primary care providers to refer patients for colonoscopy.
  
  
  METHODS
  More than 50 safety-net clinics joined the CCSP to provide colonoscopies to uninsured Coloradans with low income, aged ≥50 years or <50 years at elevated risk, lawfully present and needing CRC screening by American Cancer Society consensus guidelines.
  
  
  METHODS
  Process and clinical outcomes included people screened, show rates, patient satisfaction, and quality measures, such as adenoma detection rate, bowel cleansing quality, and timeliness of care. Program costs and benefits were estimated. The 2013 analysis was completed using 2006-2012 data on 13,252 of 13,774 people receiving colonoscopy.
  
  
  RESULTS
  In 2006-2012, the CCSP screened 13,774 people, with 38% minorities and 39% men. Patient navigators ensured >90% of those referred attended their colonoscopy. Adenomas were removed from 27% of patients and 1% had cancers diagnosed. Total direct medical services cost was $998/person receiving colonoscopy. About 325 fewer future incident CRCs were predicted due to adenoma removal, projecting substantial future cost savings.
  
  
  CONCLUSIONS
  The CCSP, a successful community clinic/academic partnership provides cost-effective CRC screening and prevention services to low-income uninsured Coloradans and establishes the infrastructure to support screening low-income Coloradans as Affordable Care Act reforms provide payer coverage for them.
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado. Electronic address: holly.wolf@ucdenver.edu.
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Wolf
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dwyer
authors.affiliation: Division of Gastroenterology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Ahnen
authors.affiliation: University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Pray
authors.affiliation: Division of Gastroenterology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Rein
authors.affiliation: Preventive Services Division, Colorado Department of Public Health and Environment, Denver, Colorado.
authors.forename: Krystal D
authors.initials: KD
authors.lastname: Morwood
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Jan T
authors.initials: JT
authors.lastname: Lowery
authors.affiliation: Colorado Access, Colorado Department of Public Health and Environment, Denver, Colorado.
authors.forename: Andrea
authors.initials: A
authors.lastname: Masias
authors.affiliation: Preventive Services Division, Colorado Department of Public Health and Environment, Denver, Colorado.
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Collins
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Brown
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Carol-Ann
authors.initials: CA
authors.lastname: DeMaio Goheen
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Keavy E
authors.initials: KE
authors.lastname: McAbee
authors.affiliation: Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Tim E
authors.initials: TE
authors.lastname: Byers
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000191:economics; D003120:Colorado; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D062526:Patient Navigation / Q000458:organization & administration; D017060:Patient Satisfaction; D011203:Poverty; D064876:Safety-net Providers / Q000191:economics / Q000458:organization & administration*; D014495:Universities