NY PREVENTION CARE MANAGER PROJECT

该项目将测试预防病例管理（PCM）的影响和衡量成本，以改善纽约市地区社区卫生中心50-69岁不同种族妇女的癌症早期检测。四个社区卫生中心的患者将被随机分配到常规护理组或PCM干预组。项目的概念框架由pre模型提供。美国国家癌症研究所癌症网的循证声明确定了乳房x光检查、巴氏涂片和粪便潜血检查以及乙状结肠镜检查的适当间隔。项目目标：1。了解这一人群在获得指定服务方面面临的障碍；2. 对各参与中心的办公环境和工作流程进行基线评估；3. 制定和实施PCM干预措施，帮助患者克服障碍；4. 在一项随机对照疗效试验中评估PCM的影响和成本。项目的第一阶段涉及目标1和目标2，将提供患者障碍和中心环境的基线评估。目标1将通过在每个中心采访多达50名系统选择的妇女来实现，以了解预防保健的障碍。目标2将通过问卷调查和与每个中心的临床支持人员的指导讨论来解决。第二阶段涉及目标3，即根据第一阶段的结果完善干预措施。干预措施包括识别逾期患者，为患者提供文化上适当的建议，协助克服护理障碍，并进行后续监测，以协助解决异常检查结果。第三阶段涉及Aim 4进行疗效试验。基于记录回顾的结果评估将比较两个研究组患者队列在基线和随访之间的预防状况，同时考虑到对1400名年龄在50-69岁的妇女的任何异常检查结果的随访状态。过程评价将允许对干预费用进行准确评估，以及对实践环境和提供预防保健过程的观察。由于这个项目，将检验一种加强特殊人群预防性保健的新模式，并确定其功效和费用。

This project will test the impact and measure the costs of a prevention case manager (PCM) to improve cancer early detection provided to ethnically diverse women age 50-69 years seen in community health centers in the New York City area. Patients of four community health centers will be randomly assigned to usual care or the PCM intervention. The conceptual framework for the project is provided by the PRECEDE model. Evidence-based statements of the National Cancer Institute's CancerNet identify appropriate intervals for mammography, Pap and fecal occult blood testing, and sigmoidoscopy. Project Aims are: 1. To learn of barriers faced by this population in obtaining indicated services; 2. To assess at baseline the office environment and work processes in each participating center; 3. To develop and implement the PCM intervention to help patients overcome barriers; 4. To evaluate the impact and costs of the PCM in a randomized controlled efficacy trial. Phase I of the project involving Aims 1 and 2 will provide a baseline assessment of patient barriers and center environments. Aim 1 will be achieved through interviewing up to 50 systematically selected women in each center to learn about barriers to preventive care. Aim 2 will be addressed through questionnaires and guided discussions with clinical support staff in each center. Phase II concerns Aim 3, to refine the intervention informed by results of Phase I. The Intervention includes identification of patients who are overdue for services, culturally appropriate patient advice, assistance in overcoming barriers to care and follow-up monitoring to assist in resolution of abnormal test results. Phase III concerns Aim 4 conducting the efficacy trial. Outcome evaluation based on record review will compare the preventive status of patient cohorts between baseline and follow- up across the two study groups taking into account the work-up status of any abnormal test results with an evaluation cohort of 1400 women age 50-69 years. Process evaluation will allow accurate assessment of intervention costs, as well as observations of the practice environments and the process of providing preventive care. As a result of this project, a new model of enhancing preventive care for special populations will be tested and its efficacy and costs determined.