RCT/Increase Colon Cancer Screening/Medicaid Managed Care

随机对照试验/增加结肠癌筛查/医疗补助管理护理

• 批准号: 7028646
• 负责人: Allen J. Dietrich
• 金额: $ 53.63万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-27 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7028646
• 关键词: Medicare /Medicaid; clinical research; colon neoplasms; colorectal neoplasms; community; diffusion; health; low socioeconomic status; managed care; migrant; prevention; urban area

DESCRIPTION (provided by applicant): Disparities persist in the colorectal cancer screening. There is need for practical, widely applicable interventions that could correct these disparities. Through previous work (R01-87776) we have developed a Prevention Care Management (PCM) intervention based on telephone support that increased colon cancer screening rates for low income women visiting community/migrant health centers in New York City almost two fold. The earlier project relied on research staff to recruit patients in community/migrant health center (C/MHC) waiting rooms and to provide the intervention, thus, limiting its transportability and sustainability. This new project in response to PAR 04-036 will be based in Medicaid Managed Care Organizations (MMCOs) which can provide sustainable, widely available infrastructures to support colon cancer screening especially for women who comprise a substantial majority of MMCO enrollees. Our first aim is to expand the scope of PCM to apply to MMCO-enrolled women who seldom visit primary care (outreach) while continuing to provide inreach to more frequent attenders. The second aim is to conduct a randomized controlled trial of the expanded PCM intervention to assess its impact on colorectal cancer screening status of low-income women age 50-64 years and to describe the process of Prevention Care Management. Several unique features of the project should be noted: the identification of women overdue for screening through MMCO claims data which is both practical to sustain and expands the reach of the project to include women who seldom visit primary care; the intervention will be delivered by established MMCO staff, not researchers appearing transiently but cannot sustain the intervention; outcomes will be assessed through MMCO claims data; and multiple representative MMCOs in New York City will be involved. Colon cancer screening will be promoted in the context of other indicated screening for breast and cervical cancer. Aim three will explore the relationship of characteristics of the women (demographics), of the community/migrant health centers that serve them, and of the MMCOs in which they are enrolled to colorectal cancer screening status including the impact of the intervention. Cost of the intervention and its relationship to increased screening rates will be assessed. The intervention and evaluation are guided by Diffusion of Innovations.

描述(由申请人提供)： 在结直肠癌筛查中，差异依然存在。有必要采取切实的、广泛适用的干预措施，以纠正这些差距。通过以前的工作(R01-87776)，我们开发了一种基于电话支持的预防护理管理干预措施，将前往纽约市社区/移民健康中心就诊的低收入妇女的结肠癌筛查率提高了近两倍。早期的项目依靠研究人员在社区/移民卫生中心(C/MHC)候诊室招募患者并提供干预，从而限制了其可移植性和可持续性。 这个响应PAR 04-036的新项目将以医疗补助管理保健组织(MMCO)为基础，该组织可以提供可持续的、广泛可用的基础设施，以支持结肠癌筛查，特别是对占MMCO参与者绝大多数的女性。我们的第一个目标是将PCM的范围扩大到适用于很少去初级保健(外展)的参加MMCO的妇女，同时继续为更频繁的来访者提供初级保健服务。第二个目的是对扩大的PCM干预进行随机对照试验，以评估其对50-年龄段低收入妇女结直肠癌筛查状况的影响，并描述预防护理管理的过程。 应当注意到该项目的几个独特特点：通过医疗管理办公室索赔数据确定逾期筛查的妇女，这对维持和扩大该项目的覆盖范围至包括很少去初级保健的妇女是可行的；干预将由现有的医疗保健办公室工作人员提供，而不是短暂出现但不能维持干预的研究人员；结果将通过医疗保健办公室索赔数据进行评估；纽约市的多个具有代表性的医疗保健办事处将参与其中。结肠癌筛查将在乳腺癌和宫颈癌的其他适应症筛查的背景下进行推广。 目的三探讨女性特征(人口学)、为她们提供服务的社区/流动卫生中心的特征以及她们登记参加结直肠癌筛查的母婴健康中心之间的关系，包括干预的影响。将评估干预成本及其与增加筛查率的关系。干预和评价以创新扩散为指导。