ENHANCING DIAGNOSTIC EVALUATION IN COLORECTAL CANCER

描述：对阳性患者进行完整的诊断评估(CDE) 粪便潜血检测结果(FOBT PLUS)是 结直肠癌筛查。专家认为CDE要么是结肠镜检查，要么是 软乙状结肠镜下双对比气钡灌肠x线检查。 这些程序需要初级保健医生(PCP)转介(S)到 胃肠病医生和结直肠外科医生和/或放射科医生。 然而，针对CDE的PCP转诊并不常见。调查人员的调查 结果和初步研究数据表明，PCP实践因素和PCP 对CDE适应症的误解可能会影响CDE转诊。 他们建议对FOBT加CDE患者的PCP转介进行研究 建立了基于HMO的结直肠癌筛查计划，包括 每年向120,000名老年人(50岁)发送FOBT邮件 宾夕法尼亚州和新泽西州。 研究分为五个阶段：(1)进行PCP焦点小组，以澄清 与CDE相关的问题和障碍，并召集专家小组开展研究 干预措施和验证患者CDE转诊状态；(2)管理 对卫生组织附属实践中的初级保健医生进行基线和终点电话调查； (3)进行干预措施的随机对照试验 改善CDE转诊和完成率(控制(N等于120)， 干预组1(N等于120)、干预组2(N等于 至120)；(4)从PCP调查和表格、医疗表收集CDE数据 审计和行政来源；以及(5)分析干预影响和 成本效益。控制组的做法将得到通常的照顾(即， USHC结直肠癌筛查计划)。干预组1 实践将得到通常的照顾，外加邮寄的CDE提醒反馈。 干预第二组将接受常规护理，邮寄CDE 提醒-反馈，和两个CDE学术详细介绍外展访问。

DESCRIPTION: Complete diagnostic evaluation (CDE) for persons with positive results on fecal occult blood testing (FOBT plus) is a key component of colorectal cancer screening. Experts consider CDE as either colonoscopy or double air-contrast barium enema x-ray (BE) with flexible sigmoidoscopy. These procedures require primary care physician (PCP) referral(s) to gastroenterologists and colorectal surgeons and/or to radiologists. However, PCP referral for CDE is infrequent. The investigators' survey results and pilot study data indicate that PCP practice factors and PCP misperceptions about indications for CDE are likely to impact CDE referral. They propose to study PCP referral of FOBT plus patients to CDE in an established HMO-based colorectal cancer screening program that involves annual FOBT mailings to 120,000 older adults (50 years of age) in Pennsylvania and New Jersey. The study has five phases: (1) conduct a PCP focus group to elucidate CDE-related issues and barriers and convene an expert panel to develop study interventions and validate patient CDE referral status; (2) administer a baseline and endpoint telephone survey to PCPs in HMO-affiliated practices; (3) conduct a randomized, controlled trial of interventions designed to improve CDE referral and completion (Control (N is equal to 120), Intervention Group 1 (N is equal to 120), Intervention Group 2 (N is equal to 120); (4) collect CDE data from PCP surveys and forms, medical chart audit, and administrative sources; and (5) analyze intervention impact and cost-effectiveness. Control Group practices will receive usual care (i.e., the USHC Colorectal Cancer Screening Program). Intervention Group 1 practices will receive usual care plus mailed CDE reminder-feedback. Intervention Group two practices will receive usual care, mailed CDE reminder-feedback, and two CDE academic detailing outreach visits.