Hub-and-Spoke centralized intervention to optimize colorectal cancer screening and follow-up: A pragmatic, cluster-randomized controlled trial protocol.
Hub-and-Spoke centralized intervention to optimize colorectal cancer screening and follow-up: A pragmatic, cluster-randomized controlled trial protocol.
复制标题
中心辐射型集中干预，以优化结直肠癌筛查和随访：实用的整群随机对照试验方案。
DOI：
10.1016/j.cct.2023.107353
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发表时间：
2023
影响因子：
2.2
通讯作者：
Martinez,MariaElena
中科院分区：
文献类型：
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作者：
Castañeda,SheilaF;Gupta,Samir;Nodora,JesseN;Largaespada,Valesca;Roesch,ScottC;Rabin,BorsikaA;Covin,Jennifer;Ortwine,Kristine;Preciado-Hidalgo,Yesenia;Howard,Nicole;Halpern,MichaelT;Martinez,MariaElena
背景指南建议筛查结直肠癌(CRC)，但参与率和异常检测随访率并不理想，人口学方面存在差异。基于证据的干预措施可以促进筛查，但社区采用和实施是有限的。方法圣地亚哥通过实施科学加速结直肠癌筛查和后续行动(ACCSIS)计划是一个学术-社区合作伙伴关系，旨在测试增加结直肠癌筛查和后续行动的中心辐射式模式的区域实施情况。该中心是一个非学术、非营利性组织，包括17个社区卫生中心(CHC)系统，为190多个农村和城市诊所提供服务。“辐条”是3个CHC系统，每个系统监督11-28个诊所，总计60多个诊所。采用整群随机试验设计，9家诊所随机接受干预，16家诊所接受常规护理。在干预诊所内，每年约有5000名未进行CRC筛查的符合条件的患者被确定进行干预。干预措施包括邀请入门读物，带有完成说明的邮寄粪便免疫化学测试，以及基于电话和文本的提醒(HUB)和患者导航协议，以促进异常匹配后完成结肠镜检查(SPEED)。结果包括：1)在干预诊所与非干预诊所三年后进行最新筛查的患者比例；2)异常配合度患者在异常结果后六个月内完成结肠镜检查的比例。收集实施科学措施以评估干预策略的可接受性、干预和日常护理适应性以及可持续性。结论这项在服务于不同人群的CHC中进行的大规模、地区性整群随机试验有望加快在服务不足的人群中预防CRC的进展。试验登记：NCT04941300
BackgroundGuidelines recommend screening for colorectal cancer (CRC), but participation and abnormal test follow up rates are suboptimal, with disparities by demography. Evidence-based interventions exist to promote screening, but community adoption and implementation are limited.MethodsThe San Diego Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) program is an academic-community partnership testing regional implementation of a Hub-and-Spoke model for increasing CRC screening and follow-up. The “hub” is a non-academic, non-profit organization that includes 17 community health center (CHC) systems, serving over 190 rural and urban clinic sites. The “spokes” are 3 CHC systems that oversee 11–28 clinics each, totaling over 60 clinics. Using a cluster-randomized trial design, 9 clinics were randomized to intervention and 16 to usual care. Within intervention clinics, approximately 5000 eligible patients not up-to-date with CRC screening per year were identified for intervention. Interventions include an invitation primer, a mailed fecal immunochemical test with completion instructions, and phone and text-based reminders (hub) and patient navigation protocol to promote colonoscopy completion after abnormal FIT (spoke). Outcomes include: 1) proportion of patients up-to-date with screening after three years in intervention versus non-intervention clinics; 2) proportion of patients with abnormal FIT completing colonoscopy within six months of the abnormal result. Implementation science measures are collected to assess acceptability, intervention and usual care adaptations, and sustainability of the intervention strategies.ConclusionThis large-scale, regional cluster randomized trial among CHCs serving diverse populations is anticipated to accelerate progress in CRC prevention in underserved populations.Trial registration: NCT04941300