ENHANCING DIAGNOSTIC EVALUATION IN COLORECTAL CANCER

描述：针对阳性患者的完整诊断评价（CDE） 粪便潜血试验（FOBT plus）的结果是 结肠直肠癌筛查 专家认为CDE是结肠镜检查或 双气对比钡灌肠X线检查（BE）和软式乙状结肠镜检查。 这些程序需要初级保健医生（PCP）转诊， 胃肠病学家和结肠直肠外科医生和/或放射科医生。 然而，PCP转诊至CDE的情况并不常见。 调查人员的调查 结果和试点研究数据表明，PCP实践因素和PCP 对CDE适应症的误解可能会影响CDE转诊。 他们建议研究PCP转介FOBT+患者到CDE的情况， 建立基于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 宾夕法尼亚和新泽西。 研究分五个阶段：（1）开展PCP焦点小组， 与CDE相关的问题和障碍，并召集一个专家小组开展研究 干预和验证患者CDE转诊状态;（2）管理 对卫生组织下属诊所的PCP进行基线和终点电话调查; (3)进行一项干预措施的随机对照试验， 改进CDE转诊和完成（对照（N等于120）， 干预组1（N等于120）、干预组2（N等于 （4）从PCP调查和表格、医疗图表中收集CDE数据 审计和行政来源;（5）分析干预的影响， 成本效益。 对照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 实践将收到常规护理和邮寄的CDE认证反馈。 干预组二将接受常规做法护理，邮寄CDE 专家反馈和两次CDE学术详细外展访问。

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.