Multilevel health system intervention to increase surveillance colonoscopy for high-risk colorectal polyps

多层次卫生系统干预，以加强对高危结直肠息肉的结肠镜检查监测

• 批准号: 10420457
• 负责人: Folasade Popoola May
• 金额: $ 64.74万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10420457
• 关键词: Address; Administrator; Algorithms; American; Cancer Control Research; Cessation of life; Clinic; Clinical; Clinical Medicine; Cluster randomized trial; Colonic Polyps; Colonoscopy; Colorectal; Colorectal Cancer; Colorectal Polyp; Cost Effectiveness Analysis; Data; Detection; Diagnosis; Disease; Documentation; Effectiveness; Electronic Health Record; Excision; Face; Foundations; Gastroenterology; Goals; Guidelines; Health; Health Sciences; Health Services Research; Health system; Healthcare Systems; Hybrids; ImProv; Incidence; Individual; Integrated Health Care Systems; Interdisciplinary Study; Intervention; Interview; Knowledge; Malignant Neoplasms; Medical Informatics; Medical Societies; Natural Language Processing; Neoplasms; Neoplastic Polyp; Outcome; Partner in relationship; Pathology; Patient Care; Patients; Polyps; Predictive Value; Primary Health Care; Provider; Randomized; Rectal Polyp; Research; Resources; Risk; Schedule; Subgroup; System; Techniques; Technology; Testing; Time; United States; Work; Workload; anticancer research; arm; base; biomedical informatics; care providers; clinical practice; colorectal cancer prevention; colorectal cancer risk; colorectal cancer screening; comparison intervention; cost; effectiveness evaluation; effectiveness testing; follow-up; health economics; high risk; high risk population; implementation cost; implementation evaluation; implementation intervention; implementation outcomes; implementation science; improved; innovation; intervention refinement; mortality; multidisciplinary; neglect; population health; portability; premalignant; primary outcome; public health relevance; screening; stakeholder perspectives; treatment as usual; uptake

Project Summary/Abstract Each year, colorectal cancer (CRC) is diagnosed in 147,950 Americans and is responsible for over 53,200 deaths in the United States (U.S). The foundation of CRC screening is the detection and removal of precancerous colon and rectal polyps, which reduces CRC incidence and mortality. One million Americans are diagnosed with high-risk neoplasia (HRN) during screening colonoscopy every year, a specific subgroup of colorectal polyps that are associated with a 2- to 5-fold increased risk for subsequent HRN, CRC, and death from CRC. HRN removal prevents CRCs and saves lives. Consequently, professional medical societies recommend that individuals with HRN undergo surveillance with repeat colonoscopy 3 years after HRN diagnosis. While many research efforts focus on increasing CRC screening for average-risk Americans, few studies address low surveillance rates in this high-risk group. Lack of surveillance after a HRN diagnosis is due to multiple factors, including patient (e.g., no knowledge surveillance is due), provider (e.g. task overload, interpretation of colonoscopy and pathology findings), and healthcare system (e.g., no tracking or recall of HRN patients at 3 years) barriers. Therefore, in order to increase HRN surveillance rates, we propose to implement and evaluate a multilevel, technology- assisted intervention that automatically and reliably identifies patients with HRN, prompts patients and providers when surveillance is due, and facilitates colonoscopy referral and scheduling. The intervention will be implemented in UCLA Health, a large academic integrated health delivery network with over 15,100 screening colonoscopies performed and approximately 1,810 HRN diagnosed annually. It harnesses the strengths of a multidisciplinary research team representing clinical medicine, health services research, medical informatics, natural language processing (NLP), population health, economics and implementation science. The specific aims of the proposed R01 are: 1) to gain stakeholder perspectives on our proposed multilevel intervention and assess potential barriers and facilitators to receipt of surveillance colonoscopy; and 2) to conduct a hybrid type 1 effectiveness-implementation cluster-randomized trial to assess the effectiveness, implementation, and cost of a multilevel intervention aimed to improve colonoscopy surveillance rates for patients with HRN. The proposed study fills an important gap in CRC prevention and focuses on a high-risk group that has been largely neglected in CRC research. Furthermore, this approach has the potential to change clinical practice, is easily portable for addressing other types of polyps and surveillance intervals, and can be adapted for other health systems that face the similar challenge of identifying and recalling patients at elevated risk for CRC.

项目总结/摘要 每年有147，950名美国人被诊断出患有结直肠癌（CRC）， 53，200人死亡（美国）。CRC筛查的基础是检测和清除 癌前结肠和直肠息肉，从而降低CRC的发病率和死亡率。一百万美国人 每年在筛查结肠镜检查期间被诊断为高危肿瘤（HRN）， 结直肠息肉与随后HRN、CRC和死亡的风险增加2- 5倍相关 从CRC。去除HRN可预防CRCs并挽救生命。因此，专业医学协会 建议HRN患者在HRN后3年进行重复结肠镜检查 诊断.虽然许多研究工作的重点是增加CRC筛查的平均风险的美国人，很少 针对这一高风险群体的低监测率进行了研究。 HRN诊断后缺乏监测是由于多种因素，包括患者（例如，没有 知识监测到期）、提供者（例如，任务过载、结肠镜检查和病理学解释 发现），和保健系统（例如，在3年时没有追踪或召回HRN患者）障碍。因此在 为了提高HRN监测率，我们建议实施和评估一个多层次的技术， 辅助干预，自动可靠地识别HRN患者，提示患者， 在监测到期时提供者，并促进结肠镜检查转诊和安排。干预将是 在加州大学洛杉矶分校健康，一个大型的学术综合健康提供网络，超过15，100筛查实施 每年进行结肠镜检查并诊断出约1，810例HRN。它利用了 代表临床医学、卫生服务研究、医学信息学、 自然语言处理（NLP），人口健康，经济学和实施科学。具体 建议的R 01的目标是：1）获得利益相关者对我们建议的多层次干预的看法， 评估接受监测结肠镜检查的潜在障碍和促进因素; 2）进行混合型 1项有效性-实施群集随机试验，以评估有效性、实施和成本 一项旨在提高HRN患者结肠镜监测率的多层次干预研究。的 一项拟议的研究填补了CRC预防的一个重要空白，并将重点放在一个高风险群体， 在CRC研究中被忽视。此外，这种方法有可能改变临床实践， 易于便携，用于解决其他类型的息肉和监测间隔，并可适用于其他类型的息肉。 卫生系统面临着识别和召回CRC高风险患者的类似挑战。