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

摘要 据估计，糖尿病患者患结直肠癌（CRC）的风险增加了27%， 非西班牙裔黑人（NHB）和西班牙裔黑人比例过高。在患者被诊断为CRC时， 有糖尿病的机会实施CRC筛查试验证明可以有效预防CRC 和降低癌症死亡率的重要性。联邦合格的健康中心（CDHCs）努力 实施针对一般风险患者的CRC计划，主要作为优先人群的初级保健 (low收入和种族/少数民族）。因此，需要有针对性的执行战略，强调 CRC筛查测试，防止CRC患者在安全网设置的风险升高。在此，主要目标 该提案的目的是确定和克服影响CRC预防性筛查最佳使用的多层次因素 糖尿病患者的治疗选择。申请人着手研究具体的种族/民族差异， CRC筛查测试在糖尿病患者中的使用，比较接受大部分护理的个体 与在传统的初级保健机构接受治疗的患者相比（目标1）。去优化和适应 执行战略，将组建一个执行规划小组。使用基于社区的 参与式研究方法，来自多个来源的数据输入（目标1结果，范围审查）将为 地方多方法组织实施评估（例如，调查和主要实施者 采访）。这些调查结果将指导实施工具包和战略的制定（目标2）。在R 00阶段， 实施工具包和策略，以优化针对糖尿病患者的CRC预防性检测， 将使用混合有效性-实施可行性试点项目（目标3）来评估区域可持续发展中心。这位候选人有 组建了一支出色的辅导团队，在出色的培训环境中帮助她实现自己的目标。 培训目标和职业转型。她的导师包括：安妮塔·金尼博士（健康差距，癌症预防）， 博士Shawna哈德逊（实施科学，基于实践的研究），Benjamin Crabtree博士（混合方法， Jeanne Ferrante博士（基于实践的研究网络招聘，主要 护理）。培训期间将允许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。在未来，该模型可以 用于研究在额外的慢性病优先级中制定有针对性的癌症预防策略 人口。该研究计划与候选人的长期目标，发展一个独立的 研究计划的重点是实施针对性的癌症预防策略，为服务不足的患者， 安全网环境中的合并症。

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.