A COMMUNITY INTERVENTION TO PROMOTE CANCER SCREENING

摘要：少数族裔、社会经济地位较低的人群和未参保人群的癌症筛查率尤其低。该项目将实施和试验一种简单、具有成本效益的办公室干预措施，以提高弱势群体的癌症筛查率。干预策略采用办公室系统方法，旨在最大限度地在常规初级保健就诊期间进行癌症筛查。办公室干预包括一套低成本的材料和对患者和办公室工作人员的明确责任，这将有助于提供者进行机会性筛查。向提供者反馈筛查率是干预措施的第二个组成部分，旨在维持干预效果。干预措施将在一项为期4年的准实验试验中进行测试，该试验涉及16家初级保健诊所，这些诊所主要服务于佛罗里达州坦帕市及其周边县的弱势群体。我们假设，在干预诊所就诊的患者比在对照诊所就诊的患者更有可能接受癌症筛查服务（巴氏涂片、乳房x光检查、粪便隐血检查）。我们还将探讨干预策略的相对成本效益和干预效果的持久性。该项目利用临床站点服务于在癌症筛查中表现出缺陷的人群。它还针对患者给出的不接受癌症筛查服务的最常见原因（医生不建议）。最后，干预措施利用了大多数患者可用的资源（初级保健诊所及其工作人员），并依靠低成本的方法来促进筛查。这些因素大大增加了成功的干预措施扩散到标准医疗保健的可能性。

ABSTACT=Racial and ethnic minorities, persons of lower socioeconomic status, and the underinsured have especially low rates of cancer screening. This project will implement and test a simple, cost-effective office intervention to increase cancer screening rates among disadvantaged populations. The intervention strategy utilizes an office system approach designed to maximize cancer screening during routine primary care visits. The office intervention consists of a low-cost kit of materials and explicit responsibilities for patients and office staffs that will help providers perform opportunistic screening. Feedback of screening rates to providers is a second component of the intervention designed to maintain intervention effects. The intervention will be tested in a 4-year quasi-experimental trial involving 16 primary care clinics that serve predominately disadvantaged populations in Tampa, Florida and the surrounding county. We hypothesize that patients attending intervention clinics will be more likely to receive cancer screening services (Pap smears, mammograms, fecal occult blood testing) than those attending control sites. We will also explore the relative cost-effectiveness of the intervention strategy and the durability of intervention effects over time. This project takes advantage of clinical sites serving populations with demonstrated deficits in cancer screening. It also targets the most common reason patients give for not receiving cancer screening services (physicians didn't recommend it). Finally, the intervention utilizes resources that are available to most patients (primary care clinics and their personnel), and relies on low cost methods to promote screening. These factors greatly increase the likelihood that a successful intervention can diffuse into standard medical care.