Optimizing Colorectal Cancer Screening PREcision and Outcomes in CommunIty-baSEd Populations (PRECISE)

结直肠癌（CRC）是美国癌症死亡的第二大原因。大多数死亡是 通过早期检测可以预防，但筛查完成和质量的失败严重损害了检测 有效性该提案将生产性PROSPR I CRC中心合并为一个单一的协作， 解决关键问题和试点干预措施，以改善CRC筛查结果。在PROSPR I中，我们 发展了强大的跨学科、多站点合作。我们收集了316个数据元素， 验证研究，创建了高质量的汇总数据集，以确定患者，提供者和系统之间的差距， CRC筛选过程中的因素和发表>60篇稿件。我们统一的PROSPR II研究中心 (PRC)将使用这些经过验证的合作和超过10年的纵向数据，为超过890万符合筛选条件的人提供服务 人（约1/40的美国合格人群），大量筛查暴露（> 840万粪便 免疫化学测试[FIT]和> 190万次结肠镜检查）和结果（> 28，000个CRC）。我国是 地理上，人口和经济上的多样性（三个州，> 800，000非裔美国人，1.6 100万西班牙裔美国人和100万亚裔美国人）。卫生系统有不同的CRC筛查模式， 不同的模式，包括所有主要的保险/报销方法（安全网，医疗保险，医疗补助， 高免赔额和预付费/按服务收费、员工模式和受激励的提供者）。 我们的PROSPR I研究确定了CRC筛查的三个方面的主要缺陷： 筛查和监测，以及何时;为什么人们不完成推荐的筛查，监测或 积极测试的后续工作;以及如何提高测试质量和准确性。项目1将确定 以及何时应该进行筛选，特别是对于那些具有相互矛盾的建议的人（例如，非洲 40-49岁的美国人和76-85岁的患者）。项目2将评估何时应进行监督 发生在癌前息肉诊断后，使用基线结肠镜检查结果和精确的新10年风险 CRC的估计数。项目3将探讨长期的筛查模式和多层次的驱动因素， 和监测没有适当地完成，特别是在研究不足的患者谁从来没有筛选，未能 重新筛查，不适当地使用监测或在筛查试验呈阳性后未能随访。项目4将 评估如何通过优化年龄和性别分层来提高FIT和结肠镜检查的有效性 定量FIT异常范围，建立精确的腺瘤检测阈值，以提高质量 以及评估腺瘤检测的驱动因素。我们将使用这些观察性研究的结果， 科学方法和利益攸关方参与制定和试点测试多层次干预措施。我们 由科学家、医生和医疗保健专家组成的跨学科团队也将为以下方面提供领导和数据： trans-PROSPR多器官协作拟议的研究可以大大减轻负担 通过减少差异和确定提高筛查完成率和有效性的方法，实现CRC的目标。

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Most deaths are preventable through early detection, but failures of screening completion and quality substantially impair test effectiveness. This proposal unites the productive PROSPR I CRC Centers into a single collaboration to address key questions and pilot interventions to improve CRC screening outcomes. In PROSPR I, we developed a strong transdisciplinary, multisite collaboration. We collected 316 data elements, performed validation studies, created high-quality pooled data sets to identify patient, provider, and system gaps in the CRC screening process factors and published >60 manuscripts. Our unified PROSPR II Research Center (PRC) will use these proven collaborations and >10 years of longitudinal data for >8.9 million screen-eligible people (~ 1 of 40 eligible people in the US), large numbers of screening exposures (>8.4 million fecal immunochemical tests [FIT] and >1.9 million colonoscopies), and outcomes (>28,000 CRCs). Our PRC is geographically, demographically and economically diverse (three states, >800,000 African Americans, 1.6 million Hispanics, and 1 million Asian Americans). The health systems have different CRC screening patterns, different modalities, and include all major insurance/reimbursement methods (safety net, Medicare, Medicaid, high-deductible and pre-paid/fee-for-service, staff-model and incentivized providers). Our PROSPR I research identified major deficiencies in three areas of CRC screening: who should get screening and surveillance and when; why people do not complete recommended screening, surveillance or follow-up of positive tests; and how test quality and accuracy can be improved. Project 1 will identify on whom and when screening should be performed, particularly for those with conflicting recommendations (e.g., African Americans aged 40-49 years, and patients 76-85 years old). Project 2 will evaluate when surveillance should occur after a precancerous polyp diagnosis, using baseline colonoscopy results and precise new 10-year risk estimates for CRC. Project 3 will explore long-term screening patterns and multilevel drivers of why screening and surveillance are not appropriately completed, especially in understudied patients who never screen, fail to re-screen, use surveillance inappropriately or fail to follow up after a positive screening test. Project 4 will evaluate how to increase the effectiveness of FIT and colonoscopy by optimizing age- and sex-stratified quantitative FIT abnormal ranges, establishing precise adenoma detection thresholds for quality improvement and evaluating drivers of adenoma detection. We will use results from these observational studies, behavioral science methods, and stakeholder involvement to develop and pilot test multilevel interventions. Our transdisciplinary team of scientists, physicians, and healthcare experts will also provide leadership and data for trans-PROSPR, multiple-organ collaborations. The proposed research can substantially decrease the burden of CRC by reducing disparities and identifying ways to improve screening completion and effectiveness.