Screening More Patients for Colorectal Cancer Through Adapting and Refining Targeted Evidence-Based Interventions in Rural Settings, SMARTER CRC

Inclusion Criteria:

* CCOs/CCO STAFF: Serving a majority of counties that are predominantly rural based on 2010 Rural-Urban Commuting Area (RUCA) codes (codes 4-10)
* CCOs/CCO STAFF: Willing to participate in data collection activities (e.g., producing claims data, interviews)
* CLINICS: Clinics will be eligible for the cluster randomization if there are 30 or more patients eligible for screening
* CLINICS: Are classified as rural according to RUCA (Codes 4-10) or Oregon Office of Rural Health designations
* CLINICS: Are served by CCOs agreeing to participate in the project
* CLINICS: Willing to implement the intervention into their clinic for the study
* CLINIC STAFF/PROVIDERS: Employed as a clinician or ancillary staff member in a participating clinic
* CLINIC STAFF/PROVIDERS: Willing to participate in data collection activities (e.g., interviews, observation, surveys)
* PATIENTS: Attributed to participating clinic
* PATIENTS: Are enrolled in Medicaid or dual eligible
* PATIENTS: Eligible for colorectal cancer (CRC) screening
* PATIENTS: For the subset of patients that will be invited to participate in key informant interviews, a 5th eligibility criteria is consented to participate
* COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: (Includes endoscopy providers, community-based outreach workers, or leaders from regional or national organizations who participate in the pilot, pragmatic trial, or scale-up study)
* COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: Involved in study activities (training, care delivery)
* COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: Willing to participate in data collection activities (e.g., trainings, interviews, surveys)
* Elderly - Yes - we anticipate that a limited number of clinic and CCO staff, or community organization representatives may be elderly; we limit our patient recruitment to those aged 45-75
* Rural - Yes
* Inner city - No
* Low income - Yes
* Disabled - Yes
* Chronic care - Yes
* End of life - Yes - This is possible, but we predict limited numbers because of the types of individuals we are recruiting: clinic and CCO staff, and patients who are not currently in hospice care
* Minorities - Yes

Exclusion Criteria:

* CLINICS: Clinics are excluded if they have current or ongoing participating in other mailed fecal testing research projects in the Medicaid population
* PATIENTS: Are current for screening
* PATIENTS: Comorbid conditions that make patients poor candidates for screening based on clinical judgment (e.g., end-stage renal disease, enrollment in hospice)
* PATIENTS: Are not an established patient or for other reasons documented by the clinics
* All patients that we recruit will be at least 45 years of age or older