Prediciting and addressing colonoscopy non-adherence in community settings

预测和解决社区环境中结肠镜检查不依从性

• 批准号: 10394857
• 负责人: GLORIA D CORONADO
• 金额: $ 57.3万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10394857
• 关键词: Address; Adherence; Adoption; Adult; Age; Appointment; Butter; Cancer Etiology; Caring; Categories; Cessation of life; Clinic; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Data; Diagnostic; Dose; Education and Outreach; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Ethnic Origin; Goals; Health; Health Care Costs; Health system; Healthcare; Incidence; Intervention; Lead; Life; Low income; Modeling; Neighborhood Health Center; New Hampshire; Outcome; Patient Care; Patients; Persons; Phase; Positive Test Result; Probability; Procedures; Process; Prospective cohort study; Quality of Care; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Resources; Risk; Screening for cancer; Sea; Services; System; Telephone; Testing; Time; Uninsured; Vulnerable Populations; Washington; arm; base; chronic care model; colorectal cancer screening; community clinic; community setting; cost; cost effectiveness; early onset colorectal cancer; effective intervention; effectiveness evaluation; follow-up; health care settings; health disparity; high risk; improved; medically underserved; mortality; patient population; patient stratification; programs; risk prediction model; safety net; screening; secondary outcome; service delivery; sex; success; tool; treatment arm; treatment as usual; uptake

PROJECT SUMMARY/ABSTRACT Colorectal cancer is the second-leading cause of cancer death in the U.S. While research has shown that colorectal cancer screening decreases colorectal cancer incidence and mortality, only 65% of eligible adults were screened at the recommended interval in 2015. Even more troubling, those who are screened do not always get timely follow-up care for abnormal results. Dr. Lynn Butterly demonstrated that patient navigation can effectively raise rates of colonoscopy uptake among low-income, uninsured patients in New Hampshire, boosting rates 27 percentage points over usual care (96.2% vs 69.3%, P<.001). Using data from the STOP CRC study of 26 community clinics, our team developed a risk prediction model that can stratify patients according to their probability of adherence with follow-up colonoscopy. Our study will answer a key pragmatic question: can patient navigation effectively improve follow-up colonoscopy among patients who have a moderate or low probability of adhering to follow-up colonoscopy; and secondarily, does the effectiveness of patient navigation differ by patients’ probability level? We will build on our successful ongoing research to test a patient-level intervention, driven by the Chronic Care Model, to increase diagnostic follow-up for colorectal cancer screening. In Aim 1, we will validate the risk prediction model, stratify patients according to risk, and adapt patient navigation materials to local resources and settings. In Aim 2, we will conduct a two-arm randomized-controlled trial involving 28 clinics (~1200 patients with positive fecal tests) and will compare patient navigation and usual care in raising rates of follow-up colonoscopy. We will assess the effectiveness (completion of colonoscopy within 1 year) of the program overall, as well as the effectiveness by category of probability of adherence to follow-up colonoscopy (moderate vs. low). This large-scale, clinic-randomized, two-arm follow-up colonoscopy program among safety net patients will leverage the expertise of our research team, which has implemented numerous systems-based interventions in multiple health care settings and used electronic health record tools to deliver clinic-based interventions. We will build on these successes in undertaking the largest study to-date addressing follow-up colonoscopy uptake among patients who receive care in safety net clinics. This study could optimize the delivery of patient navigation, support the broad adoption of patient navigation programs, and greatly improve colonoscopy follow-up rates in this vulnerable population.

项目总结/摘要 结直肠癌是美国癌症死亡的第二大原因。 结直肠癌筛查降低结直肠癌发病率和死亡率，只有65%的合格成年人 在2015年的推荐时间间隔进行筛查。更令人不安的是，那些接受筛查的人并没有 对于异常结果，始终得到及时的随访护理。林恩·巴特利博士证明了患者导航 可以有效提高新罕布什尔州低收入、无保险患者的结肠镜检查率， 提高率比常规治疗高27个百分点（96.2%比69.3%，P<0.001）。使用STOP中的数据 CRC研究26个社区诊所，我们的团队开发了一个风险预测模型，可以分层患者 根据他们坚持结肠镜检查的可能性。我们的研究将回答一个关键问题 实用问题：患者导航能否有效改善以下患者的结肠镜检查随访 有中等或低的可能性坚持后续结肠镜检查;其次， 患者导航有效性因患者概率水平而异？ 我们将建立在我们成功的正在进行的研究，以测试患者层面的干预，由慢性 护理模式，以增加结直肠癌筛查的诊断随访。在目标1中，我们将验证 风险预测模型，根据风险对患者进行分层，并根据当地情况调整患者导航材料 资源和设置。在目标2中，我们将进行一项涉及28家诊所的双臂随机对照试验 （约1200例粪便检测阳性的患者），并将比较患者导航和常规护理的提高率 结肠镜检查我们将评估有效性（1年内完成结肠镜检查）， 总体计划，以及按照遵守随访的概率分类的有效性 结肠镜检查（中度与低度）。这项大规模临床随机双臂随访结肠镜检查 在安全网患者中实施的一项计划将利用我们研究团队的专业知识， 在多种医疗保健环境中进行了大量基于系统的干预，并使用了电子健康记录 提供基于诊所的干预措施的工具。我们将在这些成功的基础上， 迄今为止，在安全网诊所接受治疗的患者中解决了后续结肠镜检查的摄取。这 研究可以优化患者导航的交付，支持患者导航的广泛采用 计划，并大大提高结肠镜检查随访率在这个脆弱的人群。

项目成果

Precision Patient Navigation to Improve Rates of Follow-up Colonoscopy, An Individual Randomized Effectiveness Trial.

• DOI: 10.1158/1055-9965.epi-20-1793
• 发表时间: 2021-12
• 期刊: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology

An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.

• DOI: 10.1186/s12885-021-09106-7
• 发表时间: 2022-01-25
• 期刊: BMC cancer
• 影响因子: 3.8
• 作者: Mojica CM;Gunn R;Pham R;Miech EJ;Romer A;Renfro S;Clark KD;Davis MM
• 通讯作者: Davis MM

Barriers and Facilitators of Colonoscopy Screening Among Latino Men in a Colorectal Cancer Screening Promotion Program.

• DOI: 10.1177/15579883231179325
• 发表时间: 2023-05
• 期刊: AMERICAN JOURNAL OF MENS HEALTH
• 影响因子: 2.3
• 作者: Mojica, Cynthia M.;Vargas, Nancy;Bradley, Savannah;Parra-Medina, Deborah
• 通讯作者: Parra-Medina, Deborah

Follow-up colonoscopy after an abnormal stool-based colorectal cancer screening result: analysis of steps in the colonoscopy completion process.

• DOI: 10.1186/s12876-021-01923-1
• 发表时间: 2021-09-28
• 期刊: BMC gastroenterology
• 影响因子: 2.4
• 作者: Coronado GD;Kihn-Stang A;Slaughter MT;Petrik AF;Thompson JH;Rivelli JS;Jimenez R;Gibbs J;Yadav N;Mummadi RR
• 通讯作者: Mummadi RR