Optimizing Colorectal Cancer Screening among Patients with Diabetes in Safety-Net Primary Care Settings: Targeting Implementation Approaches

在安全网初级保健环境中优化糖尿病患者的结直肠癌筛查：有针对性的实施方法

• 批准号: 10320056
• 负责人: DENALEE M. O'MALLEY
• 金额: $ 15.66万
• 依托单位: RBHS-ROBERT WOOD JOHNSON MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10320056
• 关键词: Adherence; Affect; Black Populations; Black race; Cancer Patient; Career Mobility; Caring; Chronically Ill; Clinic; Colonoscopy; Colorectal Cancer; Communities; Comprehensive Health Care; Data; Development; Diabetes Mellitus; Diagnosis; Effectiveness; Environment; Evaluation; Expenditure; Failure; Federally Qualified Health Center; Future; Goals; Hispanic; Individual; Intervention; Interview; Leadership; Low income; Malignant Neoplasms; Maps; Measures; Medical; Mentors; Methods; Modeling; Morbidity - disease rate; Not Hispanic or Latino; Participant; Patient Care; Patients; Phase; Population; Practice based research; Preparation; Prevention strategy; Preventive; Preventive screening; Primary Health Care; Process; Provider; Regression Analysis; Research; Research Methodology; Resources; Risk; Screening for cancer; Screening procedure; Source; Structure; Surveys; Testing; Training; Translating; acceptability and feasibility; base; cancer health disparity; cancer prevention; clinical research site; colon cancer patients; colorectal cancer prevention; colorectal cancer screening; community based participatory research; comorbidity; effectiveness evaluation; effectiveness implementation study; ethnic difference; ethnic minority; glycemic control; hands-on learning; health disparity; high risk; implementation barriers; implementation evaluation; implementation science; implementation strategy; implementation tool; improved; mortality; practice-based research network; primary care setting; programs; public health relevance; racial and ethnic; racial and ethnic disparities; recruit; safety net; screening program; social; theories; uptake; years of life lost

ABSTRACT Patients with diabetes mellitus have an estimated 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately Non-Hispanic blacks (NHBs) and Hispanic. At the point that CRC is diagnosed in patients with diabetes opportunities to implement CRC screening tests demonstrated to be effective in preventing CRC and reducing cancer mortality have been missed. Federally qualified health centers (FQHCs) struggle to implement CRC programs for average risk patients and primarily serve as primary care for priority populations (low income and racial/ethnic minorities). Thus, targeted implementation strategies are needed that emphasize CRC screening tests that prevent CRC for patients at elevated risk in safety-net settings. Herein, the main goal of the proposal is to identify and overcome multi-level factors affecting optimal use of CRC preventive screening options for patients with diabetes in FQHCs. The applicant set out to examine racial/ethnic differences of specific CRC screening test use among patients with diabetes comparing individuals who receive majority of their care in FQHCs vs patients receiving care in traditional primary care settings (Aim 1). To optimize and adapt implementation strategies, an implementation planning group will be assembled. Using a community-based participatory research method, data inputs from multiple sources (Aim 1 findings, scoping review) will inform a local multi-method organizational implementation assessment (e.g. survey and key implementation actor interviews). These findings will guide implementation toolkit and strategy development (Aim 2). In the R00 phase, the implementation toolkit and strategy to optimize CRC preventive test use targeting patients with diabetes in FQHCs will be evaluated using a hybrid effectiveness-implementation feasibility pilot (Aim 3). The candidate has assembled an exceptional mentoring team, in an outstanding training environment to help her achieve her training goals and career transition. Her mentors include: Dr. Anita Kinney (health disparities, cancer prevention), Dr. Shawna Hudson (implementation science, practice-based research), Dr. Benjamin Crabtree (mixed methods, organizational assessment), and Dr. Jeanne Ferrante (practice-based research network recruitment, primary care). The training period will allow the candidate to gain applied learning and formal training in cancer prevention, implementation science and practice-based research. In the future, the proposed model can be utilized to investigate the development of targeted cancer prevention strategies in additional chronically ill priority populations. The research program aligns with the candidate’s long-term goal of developing an independent research program focused on implementing targeted cancer prevention strategies for underserved patients with comorbidities in safety-net settings.

抽象的 糖尿病患者梅利氏症患者患结直肠癌（CRC）的风险增加了27％，并且 是不成比例的非西班牙裔黑人（NHB）和西班牙裔。在患者中诊断出CRC的时候 糖尿病的机会实施CRC筛查测试，证明可以有效防止CRC 降低癌症死亡率。联邦合格的卫生中心（FQHC）努力 平均风险患者的CRC计划和初级保健作为优先人群的初级保健 （低收入和种族/族裔少数民族）。这是需要有针对性的实施策略来强调的 CRC筛查测试可防止安全网设置风险升高的患者CRC。在此，主要目标 该提案的是识别和克服影响最佳使用CRC预防性筛查的多层次因素 FQHC中糖尿病患者的选择。申请人着手检查特定的种族/种族差异 比较接受大部分护理的个体的糖尿病患者的CRC筛查测试使用 在FQHC与在传统初级保健环境中接受护理的患者（AIM 1）。优化和适应 实施策略，实施计划小组将组装。使用基于社区的 参与研究方法，来自多个来源的数据输入（AIM 1调查结果，范围审查）将告知 本地多方法组织实施评估（例如，调查和主要实施行为者 访谈）。这些发现将指导实施工具包和战略制定（AIM 2）。在R00阶段， 实施工具包和策略，以优化CRC预防性测试使用，以针对糖尿病患者 FQHC将使用混合有效性 - 实现可行性试验进行评估（AIM 3）。候选人有 在一个出色的培训环境中组装了一支出色的心理团队，以帮助她实现她 培训目标和职业过渡。她的导师包括：Anita Kinney博士（健康差异，预防癌症）， Shawna Hudson博士（实施科学，基于实践的研究），Benjamin Crabtree博士（混合方法， 组织评估）和Jeanne Ferrante博士（基于实践的研究网络招聘，主要 关心）。培训期将使候选人获得癌症的应用学习和正式培训 预防，实施科学和基于实践的研究。将来，建议的模型可以是 用于调查针对性癌症预防策略的发展 人群。该研究计划与候选人的长期目标相吻合，即建立独立 研究计划的重点是针对服务不足的患者实施有针对性的癌症预防策略 安全网设置中的合并症。