Health care provider-directed intervention to increase colorectal cancer screening among veterans: Results of a randomized controlled trial
Health care provider-directed intervention to increase colorectal cancer screening among veterans: Results of a randomized controlled trial
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DOI：
10.1200/jco.2005.07.049
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发表时间：
2005-03-01
影响因子：
45.3
通讯作者：
Bennett, CL
中科院分区：
文献类型：
--
作者：
Ferreira, MR;Dolan, NC;Bennett, CL
结直肠癌筛查是美国最未充分利用的癌症筛查工具。本研究的目的是测试是否卫生保健提供者的直接干预增加结直肠癌筛查rate.Patients和MethodsThe研究是一项随机对照试验，在两个诊所公司在退伍军人事务部医疗中心进行。对5，711例患者的记录进行了审查; 1，978例患者符合条件。符合条件的患者为50岁及以上的男性，无结直肠癌或息肉的个人或家族史，未接受结直肠癌筛查，并且在研究期间至少有一次门诊访视。干预公司的卫生保健提供者参加了一个关于结肠直肠癌筛查的研讨会。每4到6个月，他们参加质量改进研讨会，在那里他们获得了团体筛查率，个性化的保密反馈，以及改善与识字能力有限的患者沟通的培训。审查了结直肠癌筛查建议和完成的医疗记录。识字水平进行了评估，在一个子集的patient.ResultsColorectal癌筛查的干预公司和69.4%的对照组（P = 0.02）的76.0%的患者建议。干预组中41.3%的患者完成了筛选测试，对照组为32.4%（P = 0.003）。在健康素养技能低于九年级的患者中，干预组55.7%的患者完成了筛查，而对照组为30%（P < .01）。
PurposeColorectal cancer screening is the most underused cancer screening tool in the United States. The purpose of this study was to test whether a health care provider-directed intervention increased colorectal cancer screening rates.Patients and MethodsThe study was a randomized controlled trial conducted at two clinic firms at a Veterans Affairs Medical Center. The records of 5,711 patients were reviewed; 1,978 patients were eligible. Eligible patients were men aged 50 years and older who had no personal or family history of colorectal cancer or polyps, had not received colorectal cancer screening, and had at least one visit to the clinic during the study period. Health care providers in the intervention firm attended a workshop on colorectal cancer screening. Every 4 to 6 months, they attended quality improvement workshops where they received group screening rates, individualized confidential feedback, and training on improving communication with patients with limited literacy skills. Medical records were reviewed for colorectal cancer screening recommendations and completion. Literacy level was assessed in a subset of patients.ResultsColorectal cancer screening was recommended for 76.0% of patients in the intervention firm and for 69.4% of controls (P = .02). Screening tests were completed by 41.3% of patients in the intervention group versus 32.4% of controls (P = .003). Among patients with health literacy skills less than ninth grade, screening was completed by 55.7% of patients in the intervention group versus 30% of controls (P < .01).ConclusionA provider-directed intervention with feedback on individual and firm-specific screening rates significantly increased both recommendations and colorectal cancer screening completion rates among veterans.