Prediciting and addressing colonoscopy non-adherence in community settings

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，并大大提高这一弱势群体的结肠镜随访率。

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.