NY PREVENTION CARE MANAGER PROJECT

该项目将测试预防病例经理(PCM)的影响并衡量其成本，以改善为纽约市地区社区卫生中心的50-69岁不同种族妇女提供的癌症早期检测。四个社区卫生中心的患者将被随机分配到常规护理或PCM干预。项目的概念性框架由前面的模型提供。国家癌症研究所癌症网络的循证陈述确定了乳房X光检查、巴氏和粪便潜血测试以及乙状结肠镜检查的适当间隔。项目目标是：1.了解这一人群在获得指定服务方面面临的障碍；2.在基线水平上评估每个参与中心的办公环境和工作流程；3.开发和实施PCM干预措施，帮助患者克服障碍；4.在随机对照疗效试验中评估PCM的影响和成本。该项目的第一阶段涉及AIMS 1和2，将提供患者障碍和中心环境的基线评估。目标1将通过采访每个中心系统挑选的多达50名妇女来实现，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进行有指导的讨论来解决。第二阶段涉及目标3，根据第一阶段的结果完善干预措施。干预措施包括确定哪些患者逾期接受服务、提供符合文化的患者建议、协助克服护理障碍，以及进行后续监测，以协助解决异常检测结果。第三阶段涉及进行疗效试验的目标4。基于记录审查的结果评估将在两个研究组中比较基线和随访期间患者队列的预防状态，并考虑到任何异常测试结果的工作状态与1400名年龄在50-69岁之间的女性评估队列。过程评估将允许准确评估干预成本，以及对实践环境和提供预防性护理的过程的观察。作为这一项目的结果，将测试一种加强对特殊人群的预防护理的新模式，并确定其有效性和成本。

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.