What's the "secret sauce"? How implementation variation affects the success of colorectal cancer screening outreach.
What's the "secret sauce"? How implementation variation affects the success of colorectal cancer screening outreach.
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DOI：
10.1186/s43058-020-00104-7
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发表时间：
2021-01-11
影响因子：
--
通讯作者：
Coronado GD
中科院分区：
文献类型：
--
作者：
Coury J;Miech EJ;Styer P;Petrik AF;Coates KE;Green BB;Baldwin LM;Shapiro JA;Coronado GD
邮寄粪便免疫化学检测（FIT）计划可以提高结直肠癌（CRC）筛查率，但卫生系统的实施方式各不相同（即，调整）这些方案，为他们的组织。一个健康保险计划实施了一个邮寄的FIT计划（名为Benefit），参与的卫生系统可以适应该计划。这项多方法研究探讨了哪些程序调整可能导致更高的筛查率。首先，我们通过关键卫生系统特征和项目适应性对CRC筛查率进行了描述性分析。其次，我们通过将加权回归线拟合到我们的数据来生成一个整体模型。第三，我们应用了简化比较方法（CCM）来确定条件的组合如何与更高的筛查率相关联。主要的结局指标是CRC筛查率。17个卫生系统参加了至少一年的Benefit。总体筛查完成率为20%（4-28%）在第1年和25%（12-35%）在第2年的计划。采用两种或两种以上适应措施的卫生系统有较高的筛查率，没有任何一种适应措施明显导致较高的筛查率。在第1年，只有一个诊所的小型系统使用电话提醒（n = 2）符合实施成功阈值（≥ 19%的筛选率），而当提供患者激励（n = 4）、清理邮件列表（n = 4）或允许邮寄FIT返回而不进行其他调整（n = 1）时，具有> 1个诊所的系统是成功的。在第2年，具有2-4个诊所的较大系统通过电话提醒（n = 4）或患者激励（n = 3）获得成功。在这两年实施Benefit的10个系统中，有7个系统在第2年提高了CRC筛查率。卫生系统可以在许多适应措施中进行选择，并成功地实施卫生计划的邮寄FIT计划。不同的适应组合导致成功，卫生系统规模成为一个重要的背景因素。
Mailed fecal immunochemical testing (FIT) programs can improve colorectal cancer (CRC) screening rates, but health systems vary how they implement (i.e., adapt) these programs for their organizations. A health insurance plan implemented a mailed FIT program (named BeneFIT), and participating health systems could adapt the program. This multi-method study explored which program adaptations might have resulted in higher screening rates. First, we conducted a descriptive analysis of CRC screening rates by key health system characteristics and program adaptations. Second, we generated an overall model by fitting a weighted regression line to our data. Third, we applied Configurational Comparative Methods (CCMs) to determine how combinations of conditions were linked to higher screening rates. The main outcome measure was CRC screening rates. Seventeen health systems took part in at least 1 year of BeneFIT. The overall screening completion rate was 20% (4–28%) in year 1 and 25% (12–35%) in year 2 of the program. Health systems that used two or more adaptations had higher screening rates, and no single adaptation clearly led to higher screening rates. In year 1, small systems, with just one clinic, that used phone reminders (n = 2) met the implementation success threshold (≥ 19% screening rate) while systems with > 1 clinic were successful when offering a patient incentive (n = 4), scrubbing mailing lists (n = 4), or allowing mailed FIT returns with no other adaptations (n = 1). In year 2, larger systems with 2–4 clinics were successful with a phone reminder (n = 4) or a patient incentive (n = 3). Of the 10 systems that implemented BeneFIT in both years, seven improved their CRC screening rates in year 2. Health systems can choose among many adaptations and successfully implement a health plan’s mailed FIT program. Different combinations of adaptations led to success with health system size emerging as an important contextual factor.
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作者：
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