Increasing CRC Screening in Health Plan Members

描述（由申请人提供）：结直肠癌是美国癌症死亡的第二大常见原因。早期发现和干预可以显著降低结直肠癌（CRC）的发病率和死亡率，目前的指南建议50岁以上的无症状成年人定期通过几种方式（FOBT，乙状结肠镜检查，结肠镜检查或双重对比钡灌肠）进行筛查。然而，CRC筛查在美国仍然没有得到充分利用，超过一半的成年人不遵守这些建议。由于CRC筛查利用率的关键预测因素包括医生推荐和拥有健康保险，并且鉴于增加筛查利用率的循证策略的可用性，因此在健康计划成员人群中进行有效性研究非常重要。 我们的研究团队建议与一家大型健康保险公司进行参与性研究，以测试基于社区的行为干预措施的可转移性，这些干预措施可以增加结直肠癌筛查的提供。 我们将在格鲁吉亚和北卡罗来纳州的卫生实践中进行一项随机分组试验，以测试基于录像带的决策辅助和学术细节对增加CRC筛查指南依从性的有效性。将招募30名大组患者，并随机接受常规护理（常规提醒）或组合录像带决策辅助和学术详细干预。在每个实践中，30例年龄在52 - 75岁之间，目前没有CRC筛选史的患者将入组研究。对于尚未筛选的参与者，干预将持续长达2年。主要结局将是根据美国预防服务工作组指南（FOBT、软乙状结肠镜检查、结肠镜检查或双对比钡灌肠）提供（或接受）循证CRC筛查模式。 该研究小组已经开始与全国最大的健康保险公司之一Aetna的质量改进和医疗经济学部门的主要领导人进行参与性研究。拟议的研究的独特之处包括其建立系统，以增加筛查吸收，这将有助于满足HEDIS要求的潜力;提高我们对筛查促进干预措施如何在白色和黑人人群中发挥作用的理解;并建立公共卫生和医疗保健研究人员之间的合作关系，以及健康计划和医疗保健提供者的受影响社区。

DESCRIPTION (provided by applicant): Colorectal cancer is the second most common cause of cancer death in the United States. Early detection and intervention can significantly reduce morbidity and mortality from colorectal cancer (CRC), and current guidelines recommend that asymptomatic adults overage 50 periodically obtain screening by one of several modalities (FOBT, sigmoidoscopy,colonoscopy,or double contrast barium enema). However, CRC screening remains substantially underutilized in the U.S., and more than half of all adults do not adhere to these recommendations. Because key predictors of CRC screening utilization include a physician recommendation and having health insurance, and given the availability of evidence-based strategies for increasing screening uptake, it is important to conduct effectiveness studies in health plan member populations. Our research team proposes to conduct participatory research with a major health insurer, in order to test the transferability of community based behavioral interventions that can increase provision of colorectal cancer screening. We will conduct a cluster-randomized trial in health practices in Georgia and North Carolina, to test the effectiveness of a videotape-based decision aid and academic detailing for increasing adherence to CRC screening guidelines. 30 large group practices will be recruited and randomized to receive usual care (routine reminders) or a combined videotape decision aid and academic detailing intervention. In each practice, 30 patients between the ages of 52 and 75, without current CRC screening history, will be enrolled into the study. The intervention will continue for up to 2 years for still-unscreened participants. The main outcome will be provision (or receipt) of an evidence-based modality of CRC screening according to the US Preventive Services Task Force Guidelines (FOBT, flexible sigmoidoscopy, colonoscopy, or double contrast barium enema). The research team has already begun a participatory research process with key leaders in Quality Improvement and the Medical Economics Units at Aetna, one of the nation's largest health insurers. Unique features of the proposed study include its potential to establish systems to increase screening uptake that will help fulfill HEDIS requirements; improving our understanding of how screening promotion interventions work in both White and Black populations; and forging collaborative relationships between public health and health care researchers, and the affected communities of health plans and health care providers.