Screening for Colorectal Cancer: An Integrated Approach

结肠直肠癌筛查程序的使用率很低。我们提出一个综合的， 跨学科和多层次的方法来了解和增加结肠直肠癌的使用 筛选我们将进行一系列综合目标的研究，以检查谁得到筛查， 他们接受的检查，为什么人们不接受筛查，以及最具成本效益的筛查方法是什么。 研究结果将有助于开发新的方法，干预措施和政策，以增加筛查 以及开发新的筛选方法。 具体目标是： (1)检查结直肠癌筛查利用的个人和地区水平预测因素 我们将使用来自全国健康访谈调查和医疗调查的全国代表性数据。 支出小组调查，我们将链接到提供者/计划和地区一级的数据。我们将特别关注 （a）具体的保健计划特点和（B）地区一级特点的影响。 (2)分析患者对结直肠癌筛查方法的偏好 我们将使用定量和基于经济理论的方法以及定性方法， 衡量偏好。我们将特别关注（a）患者对各种属性的重视程度 当前和新的筛查测试;（B）筛查方法的使用如何与以下偏好相关联： 这些方法;以及（c）医疗保险系统之间和内部的差异如何影响 对筛查方法、成本和支付意愿的看法。 (3)进行结直肠癌筛查的成本效益和成本效益分析 我们将采用一个先前开发的、经过验证的癌症筛查模型， 和结直肠癌筛查方法的净效益。我们将特别关注（a）的影响。 利用率（目标#1）和（B）患者对当前和新筛选方法的偏好（目标#2）。

Colorectal cancer screening procedures are highly underused. We propose an integrated, interdisciplinary, and multi-level approach to understanding and increasing the use of colorectal cancer screening. We will conduct a study with a series of integrated aims to examine who gets screening and what tests they get, why people don't get screening, and what the most cost-effective methods of screening are. The results will be useful in developing new approaches, interventions, and policies to increase screening and in developing new screening methods. Specific aims are to: (1) Examine the Individual and Area-Level Predictors of Colorectal Cancer Screening Utilization We will use nationally representative data from the National Health Interview Survey and Medical Expenditure Panel Survey that we will link to provider/plan and area-level data. We will focus particularly on the impact of (a) specific health plan characteristics and (b) area-level characteristics. (2) Analyze Patient Preferences for Colorectal Cancer Screening Methods We will use a quantitative and economic-theory based approach as well as a qualitative approach to measuring preferences. We will focus particularly on (a) how much patients value the various attributes of current and new screening tests; (b) how utilization of screening methods is associated with preferences for those methods; and (c) how differences across and within health care insurance systems influence perceptions of screening methods, cost, and willingness-to-pay. (3) Conduct Cost-Effectiveness and Cost-Benefit Analyses of Colorectal Cancer Screening We will adapt a previously developed, validated cancer screening model to examine the cost-effectiveness and net benefits of colorectal cancer screening methods. We will focus particularly on the influence of (a) utilization rates (Aim #1) and (b) patient preferences for current and new screening methods (Aim #2).