Rural Indiana Screening for Colorectal Cancer (RISCC)

About RISCC

Rural Indiana Screening for Colorectal Cancer (RISCC) is a 5-year study and collaborative effort between the IRHA and the Indiana University Simon Comprehensive Cancer Center. The study will include helping 11 rural health clinics (RHCs) implement a colorectal cancer (CRC) screening program that has been shown to help increase CRC screening rates. Baseline CRC screening rates will be identified and compared to CRC screening rates after implementing an evidence-based CRC screening intervention. After baseline rates are obtained, the RISCC study team will begin working with clinics to plan implementation that best fits each clinic’s profile.

The 9 clinics are categorized into 3 clusters, and the team will work with each cluster as a group for 12 months. The implementation plan will include identifying patients that are aged 45-75 and are not current with CRC screening. These patients will be mailed a letter and a FIT kit or Cologuard® with the option to schedule a colonoscopy. The team hopes to implement a shared decision model where eligible patients can select to screen either through a stool-based kit or colonoscopy. Resources to discuss choices are available through a Patient Navigator. The Navigator will also work with patients with positive stool-based tests to complete diagnostic colonoscopy.

During implementation, the RISCC study team will evaluate the cost of the developed plan and the degree to which clinics could maintain the CRC intervention and compare costs and CRC screening rates to those collected at baseline. Clinics will be supported by an external implementation specialist who will assist clinics in implementing a plan that is both evidence-based and fits into the clinic’s operations. Clinics will develop strategies to maintain the evidence-based approach to CRC screening after the study is completed.

The RISCC study team anticipates that the RISCC program will increase CRC screening rates, implement a sustainable screening structure, improve provider engagement in quality improvement, and, most importantly, save lives from colorectal cancer.

Participating Facilities

RHCs

Adams Medical Group - High Street
Decatur County Primary Care
Decatur Family Medicine - Woodcrest Connection
Margaret Mary Medical Arts Center
Monroe Family Medicine
Osgood Primary Care
Tree City Medical Partners

Hospitals Offering Colonoscopy Services

Adams Memorial Hospital
Margaret Mary Health

Organizations Providing Supplies/Services to Underinsured/Uninsured Patients

CheckIt4Andretti Foundation for Colonoscopies
Exact Sciences for Cologuard® Kits
Polymedco for FIT Kits
Sebela Pharmaceuticals for Prep Supplies (SUPREP, SUTAB, SUFLAVE)

Community Advisory Board Members

The Community Advisory Board (CAB) is a group of staff and patients from the local communities that meet with the RISCC study team 2-3 times each year. The CAB is responsible for offering general advice to the study investigators throughout the study, reviewing study-specific materials and procedures, introducing investigators to key personnel/staff, and assisting with dissemination of the study.

The RISCC team would like to recognize the following individuals for serving their clinic and community by participating on the CAB:

Clinic Administrator Representative
Brad Goshorn, FACHE, ACMPE, CRHCP
Director of Provider Services, Adams Health Network

Care Provider Representative
Nicholas Nussbaum, MD
Director of Medical Affairs / Community Services, Adams Health Network

Patient Advocate
Amber Knueven
Population Health Nurse, Margaret Mary Health

 

RISCC Study Team

Indiana University Simon Comprehensive Cancer Center

Victoria Champion, PhD, RN, Co-Principal Investigator, is a Distinguished Professor at Indiana University and the Associate Director of Population Science and Community Outreach at Indiana University Simon Comprehensive Cancer Center (IUSCCC). Champion has over 3 decades of peer reviewed cancer prevention and control research funded by the National Institutes of Health and American Cancer Society. A large part of her work has been developing and testing interventions to increase population screening, especially in underserved populations including rural and African American.

Teresa Damush, PhD, Co-Principal Investigator, is an Implementation Scientist and Professor of Medicine with Indiana University School of Medicine and the VA Medical Center in Indianapolis. Dr. Damush's research includes developing and implementing strategies for clinical teams to implement evidence-based practices based on local adaptation and evaluate those practice improvements on quality and patient outcomes.

Tom Imperiale, MD, Co-Principal Investigator, has derived and validated risk prediction models that estimate and stratify risk for the combination of colorectal cancer and advanced pre-cancerous polyps in individuals not identified as high risk through genetic predisposition or medical co-morbidities. Dr. Imperiale will lead the implementation of a risk-based prediction model and algorithm for CRC screening that can be embedded in a text that accompanies mailing of an informational letter and FIT kit. Using this embedded text link, persons identified as higher-than-average risk for CRC will be provided information about the preference / importance / necessity of having a screening colonoscopy.

Patrick Monahan, PhD, Co-Investigator, is a Professor of Biostatistics and Health Data Science. He is an expert in quantitative psychometrics and applied biostatistics for behavior research. Dr. Monahan’s research collaborations over the past 20 years have included underserved populations including rural and African American. His passion in life is helping to facilitate success for persons experiencing homelessness. Dr. Monahan will oversee analytic issues, including power and sample size determination, as well as statistical analysis.

Bronson Dokmanovich, BS is a Senior Data Manager for IU Department of Biostatistics and Health Science. He graduated from Indiana University-Purdue University Indianapolis in 2021 with a major in Biology and minor in Chemistry. He is currently continuing his education at IU Fairbanks School of Public Health earning his master’s in public health (MPH) with a concentration in epidemiology. He currently works with data from a wide variety of cancer related studies which range from radiation oncology to oncology communication studies. Bronson will assist in data collection, data quality assurance, and preparation for data analysis. 

Amanda Bishop, MSN, RN, NPD-BC is an Implementation Specialist for Indiana University School of Nursing in Indianapolis. She graduated from Milligan University with a Bachelor of Science in Business Administration and Accounting. After working in this field for many years, she decided to pursue a career in nursing. Upon obtaining an Associate of Science in Nursing from Ivy Tech
Community College, she attended Ball State University and graduated in 2020 with a Master of Science in Nursing Education. Her nursing experience has focused on cardiovascular critical care and nursing professional development and education.

Bunmi Adeola is a Clinical Research Coordinator for Indiana University School of Nursing at Indianapolis. She graduated with a Bachelor of Science degree in Biology from Indiana University Purdue University Indianapolis. She has prior experience working on federally funded research studies and has just recently worked on a National Institutes of Health (NIH) funded grant with the Department of
Cardiology, Operative Dentistry and Dental Public Health at the IU School of Dentistry. She will serve as the project manager and coordinator for the study. 

University of South Florida

Laura Szalacha, PhD, is a Professor in Research Methodology and Biostatistics at Morsani College of Medicine and College of Nursing at the University of South Florida. Dr. Szalacha is a consultant bringing extensive experience as the statistician on federally funded longitudinal research grants primarily focused on cancer screening and is presently the methodologist and statistician on an implementation grant regarding Colorectal Screening with American Indian tribes and nations in Arizona. She conducts both qualitative and mixed methods research and will work with the team primarily in the interpretation of the qualitative data its relationship to the quantitative analyses. 

University of Texas (Cost Effectiveness)

David R. Lairson, PhD, is a Professor of Health Economics and Director, Center for Health Services Research at the University of Texas Health Science Center at Houston, School of Public Health. He will lead the cost-effectiveness evaluation of the study. He previously directed the economic evaluation components of National Cancer Institute and CDC funded randomized trials of behavioral interventions to increase compliance with mammography, colorectal cancer, and cervical cancer screening guidelines. He has authored several publications on the economic results of prevention and treatment trials and is co-author of the 4^th edition of a text, Evaluating the Healthcare System: Effectiveness, Efficiency, and Equity, Health Administration Press, spring 2013.    

Paul G. Yeh, MD, DrPH, is a Faculty Associate in the Department of Management, Policy, and Community Health at the University of Texas Health Science Center at Houston, School of Public Health. He will co-lead the cost-effectiveness evaluation of the study. He is leading the economic evaluation components of National Cancer Institute funded randomized trial focused on the management of breast cancer survivors. His other research interests include the economic evaluation of screening interventions and the use of behavioral promotion interventions to improve cancer screening uptake in Hispanic and rural communities.

Indiana Rural Health Association

Ally Orwig, MBA, a Senior Director, has been with IRHA for nearly 14 years. She has an MBA from the University of Southern Indiana and a Bachelor degree in English from Indiana State University. Orwig is responsible for IRHA's Indiana Telehealth Network, Lunch & Learn series, and InSRHN Community Health Needs Assessments, and she assists the Woodlawn Hospital rural residency development grant in addition to the RISCC program.  She has served in many capacities at IRHA with previous experience in quality reporting, suicide reduction, and Opioid Use Disorder. Orwig is passionate about her role with Indiana Rural Health Association and cancer prevention efforts throughout the state. 

Heather Grable, MS, RRT, has been with Indiana Rural Health Association (IRHA) since May 2017. Ms. Grable is a Program Director at IRHA, the Rural Health Clinic Network Director, and works collaboratively with the Indiana University Simon Cancer Center as well as a Program Coordinator for Healthy Start Communities that C.A.R.E. (HSCC). Previously, she was the program coordinator for the IRHA Rural Medical Maternity Home (RMMH). Ms. Grable has provided local, state, and national presentations highlighting successful HRSA projects and other topics specific to rural healthcare. She currently serves on the Indiana Department of Health Maternal Health Taskforce and Monroe Regional Fetal and Infant Mortality Review (FIMR) Board.