In this project, we will partner with four federally qualified health centers (FQHCs), which have multiple clinics in the Chicago and Cook County area and provide primary care services to racial/ethnic minority and low-income populations. Together, these 4 FQHCs served 188,037 patients in 2016. During the UG3 Planning-Exploratory Phase, we will work with one of the 4 partner FQHCs to pilot test, measure, and refine our proposed multilevel intervention in preparation for the experimental trial in the UH3 Implementation Phase. In the UH3 Implementation Phase, we will use a stepped wedge cluster randomized trial design to examine the effectiveness and impact of our proposed multilevel intervention on increasing rates of CRC screening, follow-up, and referral-to-care across the 4 partner FQHCs. The selection of our intervention components will be based on intensive literature review, and findings and lessons learned from our previous studies and projects, especially our current CDC Colorectal Cancer Control project. We will target 4 different levels of influence (organization, provider, community and individual). Our multilevel intervention components will include EMR provider reminders, provider assessment and feedback, patient navigation, provider and staff education and community outreach.


Screening for colorectal cancer (CRC) not only detects disease early but also prevents cancer by finding and removing precancerous polyps. Illinois ranks in the last quartile for CRC screening rates across the nation, which has no doubt been a contributor to its high CRC incidence [1]. Cook County is the most populous county in Illinois and has the most diverse population with significantly higher numbers of African Americans, Hispanics, Asian Americans, as well as people who are living below 200% of the poverty level [2]. Cook County has one of the highest CRC mortality rates in Illinois. 54% of the county residents reside in Chicago. In fact, Chicago has the 2nd largest African American, 4th largest Hispanic and 5th largest Asian American population in the nation. 

Specifically: All populations in Cook County and Chicago especially areas with high concentrations of racial/ethnic minority and low-income populations


  • PCC Community Wellness Center


UG3 Planning and Exploratory Phase: 

  • Aim 1: Understand how to best increase the adoption, implementation, and sustainment of evidence-based interventions using retrospective and prospective data collected from our current CDC funded project, which uses a multilevel and organized approach to increase CRC screening rates in a FQHC. 
  • Aim 2: Develop implementation support strategies to accelerate the adoption and implementation of evidence-based interventions based on the findings from Aim 1. 
  • Aim 3: Conduct a pilot study in one new FQHC to assess the feasibility and effectiveness of our multilevel intervention, as well as our implementation support strategies developed from Aim 2. 
  • Aim 4: Refine the proposed multilevel intervention and implementation support strategies based on the findings and lessons learned from Aim 3. 


UH3 Implementation Phase: 

  • Aim 5: Implement the refined multilevel intervention in another 3 new partner sites (in addition to the pilot test site in the UG3 Phase) and use a stepped wedge design with multiple data collection points to evaluate the effectiveness of the proposed multilevel, multicomponent intervention within and across levels through multilevel modeling. 


Helen Lam, RN, PhD, Director of Research and Evaluation,