Date of Award

Spring 2022

Project Type

Clinical Doctorate

College or School




Program or Major

Doctor of Nursing Practice

Degree Name


First Advisor

Gene Harkless

Second Advisor

Catherine Fogg

Third Advisor

Cathleen Colleran



Background: Colorectal cancer (CRC) is a leading cause of death from cancer in the United States, despite the availability of several high-quality screening options. Multiple barriers to CRC screening have been identified, including cost (non-insured), younger age, racial or ethnic minority, recent immigration to the U.S. (non-English speaking), fear or distrust of the healthcare system and rural residence. Addressing health equity within underserved populations requires improved access to CRC screenings per evidence-based guidelines.

Local Problem: The mean CRC screening rate for the designated Federally Qualified Health Center (FQHC) was 33.7% for the 5 months preceding this quality improvement (QI) project. The Community Health Access Network Unified Data System (CHAN UDS) benchmark target for CRC screening was 60.1%.

Methods: Multiple targeted interventions were implemented over a 4-month period that emphasized a strong provider recommendation, a team-based approach to identify and offer CRC screening options to patients who were overdue for testing, and accurate documentation of results in the electronic medical record (EMR). A chart audit was followed by a mailed fecal immunochemical test (FIT) and colonoscopy reminder letter initiative.

Results: The CHAN UDS performance metric for CRC screening reached 40% within 4 months. The second chart audit (2 months after the first) confirmed the CRC screening rate improved to 41.5% among FQHC patients aged 50 to 75 years. An overall 55% return rate was achieved with the mailed FIT initiative within 2 months.

Conclusions: Despite an improvement in the CRC screening rate, continued quality improvement initiatives are needed to achieve the CHAN UDS benchmark target for this FQHC. The global aim of this QI project, to reduce or remove barriers to CRC screening test completion, was demonstrated in the results. These team-based interventions can be utilized within other underserved patient populations to improve health equity for CRC screening.