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27% 不成比例的是非西班牙裔黑人(NHBs)和西班牙裔美国人。在患者被诊断为结直肠癌的时候 糖尿病实施CRC筛查测试的机会被证明对预防CRC有效 以及降低癌症死亡率都被忽略了。联邦合格的健康中心(FQHC)努力 为中等风险患者实施CRC方案，并主要为优先人群提供初级保健 (低收入和种族/少数族裔)。因此，需要有针对性的执行战略，强调 CRC筛查测试，可在安全网环境中预防高危患者的CRC。在这里，主要目标是 该建议的目的是找出并克服影响最佳使用结直肠癌预防性筛查的多层次因素 FQHC中糖尿病患者的选择。申请者着手研究特定的种族/民族差异。 CRC筛查试验在糖尿病患者中的应用比较接受主要护理的个体 在FQHC与在传统初级保健环境中接受护理的患者(目标1)。优化适应 在执行战略方面，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调查结果，范围审查)将为 当地多方法组织执行情况评估(例如，调查和主要执行行为者 采访)。这些调查结果将指导执行工具包和战略制定(目标2)。在R00阶段， 针对糖尿病患者优化CRC预防性检测使用的实施工具包和策略 将使用有效性-执行可行性混合试点(目标3)对合格的初级保健中心进行评估。候选人有 组建了一支出色的指导团队，在出色的培训环境中帮助她实现了目标 培养目标和职业转型。她的导师包括：Anita Kinney博士(健康差距、癌症预防)， Shawna Hudson博士(执行科学、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，初级 关爱)。培训期间将允许候选人获得癌症方面的应用学习和正式培训 预防、实施科学和实践性研究。在未来，提出的模型可以 用于调查在其他慢性病优先事项中有针对性的癌症预防策略的发展 人口。这项研究计划符合候选人发展独立人才的长期目标 研究计划侧重于为未得到充分服务的患者实施有针对性的癌症预防战略 安全网环境中的并存问题。

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.