Systems of Support (SOS) to Increase Colon Cancer Screening and Follow-up

描述（由申请人提供）：结直肠癌筛查（CRCS）降低了结直肠癌的死亡率和发病率，然而，40-60%的符合条件的成年人没有按照推荐的间隔进行筛查，而且许多人从未接受过任何类型的CRCS。筛查失败的原因是缺乏筛查和阳性检测的随访失败。改善CRCS采用的战略通常侧重于患者或卫生保健提供者，而没有描述实施和维持这些变化所需的基础设施变化或支持系统（SOS）。我们提出了一个两部分的研究使用慢性护理模式组织SOS。我们将确定一组年龄在50 -75岁、CRCS不符合国家指南的群体健康患者。在A部分：受试者将随机接受逐步增加支持强度的四种干预措施之一：1。常规护理（UC）。2.自动化支持（UC+邮寄信息，粪便隐匿卡（FOBT）和提醒，以及访问癌症筛查热线以讨论其他筛查方案）。辅助支持（UC+自动化+医疗助理记录选择并帮助患者通过已提供的资源完成选择或向患者的医生发送请求）。4.护士护理管理支持（UC +自动化+辅助+癌症筛查护士，通过澄清患者CRCS意图、评估程序风险、安排检查并协助完成行动计划来管理患者护理）。在B部分：FOBT阳性或乙状结肠镜检查阳性（需要结肠镜检查）的患者将随机分配到两个随访干预组之一。A.UC（在Group Health包括注册和医生提醒）或b .护士护理管理（UC +癌症筛查护士，在检测呈阳性后管理护理）。我们的研究假设是：1。SOS水平的增加将导致CRCS率的增加。癌症筛查护士的护理管理将增加阳性检测后的随访率。主要的具体目标是：1。比较各干预条件对提高CRCS率的效果。比较筛查试验阳性后各干预条件的随访效果。评估各干预条件对参与者与CRCS依从性和医疗服务满意度相关的认知、情感和社会因素的影响比较每种干预条件的利用率、成本和增量成本效益

DESCRIPTION (provided by applicant): Colorectal cancer screening (CRCS) decreases colorectal cancer mortality and incidence however, 40-60% of eligible adults are not screened at recommended intervals, and many have never had any type of CRCS. Screening failures occur from both lack of screening and breakdowns in follow-up of positive tests. Strategies for improving the uptake of CRCS typically focus on either patients or health care providers, without describing the infrastructure changes, or systems of support (SOS), that are required to implement and sustain these changes. We propose a two-part study using the Chronic Care Model to organize SOS. We will identify a cohort of Group Health patients aged 50 -75 years whose CRCS is not current according to national guidelines. In Part A: Subjects will be randomized to receive one of four interventions of stepwise increasing intensity of support: 1.Usual care (UC). 2.Automated support (UC+ mailed information, fecal occult cards (FOBT) and reminders, and access to a cancer screening hotline to discuss other screening options). S.Assisted support (UC+ automated + a medical assistant to record choice and assists patients in completing the choice via the resources already supplied or sending requests to the patient's physician). 4.Nurse care management support (UC + automated + assisted + a cancer screening nurse who manages patient care by clarifying patient CRCS intent, assessing procedural risk, ordering tests, and assists with completion of the action plan). In Part B: Patients with a positive FOBT or flexible sigmoidoscopy (colonoscopy needed) will be randomized to one of two follow-up intervention arms. A.UC (which at Group Health includes a registry and physician alerts) or B.Nurse care management (UC + cancer screening nurse who manages care after a positive test. Our study hypotheses are that: 1. increasing levels of SOS wil result in increasing CRCS rates and 2. care management by cancer screening nurses will increase follow-up rates after a positive test. The primary specific aims are: 1. To compare the effectiveness of each intervention condition on increasing CRCS rates 2. To compare the effectiveness of each intervention condition on follow-up after a positive screening test The secondary aims are: 3. To assess the effects of each intervention condition on participants' cognitive, affective, and social factors related to CRCS adherence and satisfaction with medical services 4. To compare utilization, costs, and incremental cost-effectiveness of each intervention condition