New Community Partnership To Expand Access to Colorectal Cancer Screening Across New Haven

A new partnership between Yale School of Medicine (YSM) and the New Haven community is taking aim at one of the most preventable yet persistent causes of cancer deaths: colorectal cancer. Through the Community Health Equity Accelerator initiative, the Office of Health Equity Research has awarded funding to a team led by Ilana Richman, MD, MHS, and Karen Xiao, MD, of YSM, and colleagues at Cornell Scott–Hill Health Center to close gaps in screening and follow-up care. The one-year pilot project, supported by Yale Cancer Center, will test new ways to make screening easier, more effective, and more responsive to local needs.

The initiative builds on Cornell Scott–Hill Health Center’s strong foundation of community care, combining the reach of primary care clinics with the research and evaluation capacity of YSM. Led in partnership with Michael Couturie, MD, and Christine Chen, MD, at Cornell Scott–Hill Health Center, the team will design and evaluate a multilevel intervention that includes text and letter reminders for patients, electronic prompts for clinicians, and systematic tracking of patients who are overdue for testing or follow-up.

Screening has been shown to reduce the risk of dying of colorectal cancer, according to Richman, assistant professor of medicine (general medicine). “But there are still gaps in who gets screened, especially among people receiving care in community health centers,” she says. “That’s the challenge we’re hoping to address.”

The project is an exciting way to help patients complete their colorectal cancer screening test by seeing what type of reminders work, says Xiao, assistant professor of medicine (digestive diseases).

“We know that life is busy and that patients, especially those served by community health centers, face multiple challenges to completing these tests,” Xiao says. “We hope that the right type of motivating reminder at the right time will help lower these barriers.”

To find the most effective outreach methods, the team will test multiple communication approaches — ranging from simple health reminders to messages that emphasize community norms or personal motivation.

“Different people are motivated by different things,” Richman explains. “Some respond to a positive message about improving health, while others might connect with a personal story or social encouragement. We want to know what resonates most with our patients.”

Community input will also play a central role. A patient advisory panel will review draft messages to ensure that the language is clear, respectful, and empowering.

“It’s easy to send out a message that’s impersonal — or worse, one that is confusing,” says Richman. “We want messages that are appealing for the right reasons and help people understand why screening matters.”

Richman sees this collaboration as part of a broader effort to strengthen the link between Yale and the city it serves. “Cornell Scott–Hill Health Center and YSM have a long-standing relationship, with shared clinical sites and resident training,” she says. “It’s a partnership that allows us to build on each other’s strengths.”

For both Richman and Xiao, the impact extends far beyond the initiative.

“Our proposed interventions are relatively low-cost and use infrastructure already present at Cornell Scott–Hill Health Center ,” Xiao says. “If effective, we hope that these interventions can be implemented by other community health care centers.”

“The big-picture goal is to improve health by preventing disease,” Richman adds. “But it’s also about creating the infrastructure and relationships we need to keep doing this kind of work — right here in our own backyard.”

The Department of Internal Medicine at Yale School of Medicine is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.