NY PREVENTION CARE MANAGER PROJECT

达特茅斯医学院（DMS）和临床主任网络（CDN）正在合作开展这一补充的母项目，该项目一直在测试电话支持对接受纽约市社区卫生中心初级保健的妇女的乳腺癌、宫颈癌和结肠直肠癌筛查的影响。我们现在已准备好推进传播工作（附件A-支持信）。母项目在一项随机对照试验中招募了11个社区/移民健康中心（C/MHCs）的1,400多名50-69岁的妇女。一半的妇女被指定通过预防护理管理接受电话支助服务，另一半则接受常规护理。通过一系列电话，经过培训、质量得到监测的预防保健管理人员采用了一种手动方法，向妇女提供有关逾期筛查测试的知识，帮助妇女克服获得所需服务的障碍，并提供后续支助。我们的方法论文正在修订中。 目前的初步分析显示，PCM干预对所有三种癌症的筛查产生了积极影响。 例如，使用PCM，结直肠癌筛查率比基线增加了近100%。 在我们的疗效数据的力量，我们建议传播PCM干预的优先分组的妇女-那些登记与医疗补助管理的医疗机构和逾期筛选-使用一种实用的方法，以提高他们的护理，将是可持续的，在现实世界中的设置没有研究的支持。 母项目依靠研究人员密切监督的研究人员。 患者通过密集的研究驱动过程进行识别，招募和同意。 在本补充中，母项目团队将与Affinity Health Plan（一家医疗补助管理式护理组织）合作，以便Affinity在创新传播理论的指导下，为覆盖的妇女开发、提供和维持PCM干预的能力。 PCM干预措施是美国预防服务工作组（USPSTF）建议的促进乳腺癌、宫颈癌和结肠直肠癌筛查的创新措施。 PCM是对护理过程的增强，即患者获得癌症筛查的事件序列。 由于在本建议书的开头必须区分其他事件顺序：在Affinity MMCO上下文和其他地方实施PCM的变更过程。 该补充文件将允许在三个层面上研究PCM创新的传播： 1.个人-亲密关系所涵盖的妇女被分配到PCM干预（一个护理过程）; 2.组织-MMCO本身，在母项目的初步援助下，将实施和重新设计PCM，使其具有可持续性（一个变革过程）; 3.以及其他没有参与本补充的区域MMCO和社区卫生中心-作为我们的母项目和此处提出的传播工作的结果，这些组织考虑实施PCM（一个变革过程）。

Dartmouth Medical School (DMS) and Clinical Directors Network (CDN) are collaborating on the parent project to this supplement, which has been testing the impact of telephone support on the breast, cervical, and colorectal cancer screening of women who receive primary care from community health centers for the underserved in New York City. We are now ready to move forward with dissemination (Exhibit A-Letters of support). The parent project enrolled over 1,400 women age 50-69 years seen in 11 Community / Migrant Health Centers (C/MHCs) in a randomized controlled trial. Half of the women were assigned to receive telephone support services through Prevention Care Management (PCM), while the other half received usual care. Through a series of telephone calls, trained, quality-monitored Prevention Care Managers have used a manualized approach to provide knowledge to women about overdue screening tests, helped women overcome barriers to obtaining needed services, and provided follow up support. Our methods paper is in revision. Current preliminary analyses show a positive impact of the PCM intervention on screening for all three cancers. For example, colorectal cancer screening rates increased almost 100% over baseline with PCM. On the strength of our efficacy data, we propose to disseminate the PCM intervention to a priority subgroup of women-those enrolled with Medicaid managed care organizations and overdue for screening-using a practical approach to enhance their care that will be sustainable in real-world settings without research support. The parent project relied on research staff closely supervised by research investigators. Patients were identified, recruited and consented through an intensive research-driven process. In this supplement, tha parent project team will work with Affinity Health Plan, a Medicaid managed care organization (MMCO), so that Affinity develops the capacity for, provides and sustains the PCM intervention to covered women guided by Diffusion of Innovations theory. The PCM intervention, promoting screening for breast, cervical and colorectal cancer as recommended by the US Preventive Services Task Force (USPSTF), is the innovation under consideration. PCM is an enhancement to the process of care, i.e. the sequence of events by which patients obtain cancer screening. As additional sequence of events is important to distinguish at the outset of this proposal: the process of change by which PCM is implemented within the Affinity MMCO context and elsewhere. This supplement will allow study of dissemination of the PCM innovation at three levels: 1. Individuals-Affinity covered women assigned to the PCM intervention (a process of care); 2. The organization-the affinity MMCO itself, that with initial assistance from the parent project will implement and reinvent PCM to be sustainable (a process of change); 3. And other regional MMCOs and community health centers that are not participating in this supplement- as results from our parent project and dissemination work proposed here are presented and these organizations consider implementing PCM (a process of change).