Clinical case management and navigation for colonoscopy screening in an academic medical center
Clinical case management and navigation for colonoscopy screening in an academic medical center
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DOI：
10.1002/cncr.28156
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发表时间：
2013-08-01
期刊：
影响因子：
6.2
通讯作者：
Anderson, Joseph C.
中科院分区：
文献类型：
--
作者：
Cavanagh, Mary F.;Lane, Dorothy S.;Anderson, Joseph C.
背景5个国家资助的疾病控制和预防中心结直肠癌（CRC）筛查示范项目之一，项目SCOPE，在一个学术医疗中心进行，并为当地社区卫生中心服务不足的少数民族患者免费提供结肠镜筛查。通过主要项目工作人员的临床护理协调，解决目标人群的经济、语言、交通等方面的问题。临床医生与患者导航器的使用允许在几乎所有患者中进行结肠镜检查前电话访视，而不是到胃肠科医生办公室访视。临床医生收集与筛选决策相关的信息（例如，既往病史和手术史、系统重点审查、药物/补充剂使用、CRC筛选史）。患者导航仪减少障碍，包括但不限于，调度，运输，和物理导航的医疗中心的结肠镜检查的一天。结果Preprogram的准备是至关重要的，在奠定基础的项目，但增强程序正在进行整个筛选期间。来自初级保健医生的详细转诊表，加上电话访谈中获得的信息，促进了高结肠镜检查完成率和良好的患者满意度。同样有价值的是雇用双语患者导航员，谁提供了实际和情感的病人supports.CONCLUSIONS学术医疗中心可以提供CRC筛查弱势群体的有效模式。由预防医学部门协调护理，指导招募，调度，预筛选教育，以及目标人群的评估和准备，对社区卫生中心患者的结肠镜检查CRC筛查具有总体积极影响。Cancer 2013;119（15 suppl）：2894-904. (c)2013年美国癌症协会.通过项目SCOPE（萨福克县预防性内镜检查），一个学术性的结肠直肠癌筛查医疗中心模型，消除了社区卫生中心患者中结肠镜检查筛查的现有障碍。临床病例管理与患者导航相结合提供了个性化的患者支持，这有助于在40个月的筛查期内对800名患者进行筛查。
BACKGROUND One of 5 nationally funded Centers for Disease Control and Prevention Colorectal Cancer (CRC) Screening Demonstration Programs, Project SCOPE, was conducted at an academic medical center and provided colonoscopy screening at no cost to underserved minority patients from local community health centers.METHODS Established barriers to CRC screening (eg, financial, language, transportation) among the target population were addressed through clinical coordination of care by key project staff. The use of a clinician with a patient navigator allowed for the performance of precolonoscopy telephone visits instead of office visits to the gastroenterologist in virtually all patients. The clinician elicited information relevant to making screening decisions (eg, past medical and surgical history, focused review of systems, medication/supplement use, CRC screening history). The patient navigator reduced barriers, including, but not limited to, scheduling, transportation, and physical navigation of the medical center on the day of colonoscopy.RESULTS Preprogram preparation was vital in laying groundwork for the project, yet enhancements to the program were ongoing throughout the screening period. Detailed referral forms from primary care physicians, coupled with information obtained during telephone interviews, facilitated high colonoscopy completion rates and excellent patient satisfaction. Similarly valuable was the employment of a bilingual patient navigator, who provided practical and emotional patient support.CONCLUSIONS Academic medical centers can be efficient models for providing CRC screening to disadvantaged populations. Coordination of care by a preventive medicine department, directing the recruitment, scheduling, prescreening education, and the evaluation and preparation of target populations had an overall positive effect on CRC screening with colonoscopy among patients from a community health center. Cancer 2013;119(15 suppl):2894-904. (c) 2013 American Cancer Society.Through Project SCOPE (Suffolk County Preventive Endoscopy), an academic medical center model for colorectal cancer screening, existing barriers to colonoscopy screening among community health center patients are removed. Clinical case management coupled with patient navigation provides individualized patient support, which facilitates the screening of 800 patients over a 40-month screening period.