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

加强结肠癌筛查和随访的支持系统 (SOS)

• 批准号: 8079546
• 负责人: Beverly Beth Green
• 金额: $ 52.45万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8079546
• 关键词: Access to Information; Adherence; Adult; Affective; Caring; Cognitive; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Failure; Flexible fiberoptic sigmoidoscopy; Guidelines; Health; Health Personnel; Hotlines; Incidence; Intervention; Mails; Managed Care; Medical; Nurses; Nursing Care Management; Participant; Patient Care; Patients; Physicians; Randomized; Registries; Research Infrastructure; Resources; Risk; Screening for cancer; Screening procedure; Services; Support System; Testing; aged; arm; chronic care model; cohort; colorectal cancer screening; compare effectiveness; cost; cost effectiveness; follow-up; improved; mortality; satisfaction; social; treatment as usual; uptake

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

描述（由申请人提供）：结直肠癌筛查 (CRCS) 可以降低结直肠癌死亡率和发病率，但是，40-60% 的合格成年人没有按建议的时间间隔进行筛查，而且许多人从未接受过任何类型的 CRCS。筛查失败的原因包括缺乏筛查和阳性检测随访失败。提高 CRCS 接受率的策略通常侧重于患者或医疗保健提供者，而不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)。我们提出了一项由两部分组成的研究，使用慢性护理模型来组织 SOS。我们将确定一组年龄在 50 -75 岁的团体健康患者，根据国家指南，这些患者的 CRCS 尚未达到当前状态。在 A 部分中：受试者将被随机接受四种干预措施中的一种，并逐步增加支持强度： 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选项）。 S.辅助支持（UC+自动化+医疗助理记录选择并通过已提供的资源或向患者的医生发送请求协助患者完成选择）。 4.护理管理支持（UC + 自动化 + 辅助 + 一名癌症筛查护士，通过澄清患者 CRCS 意图、评估程序风险、安排测试并协助完成行动计划来管理患者护理）。 B 部分：FOBT 或可屈性乙状结肠镜检查（需要结肠镜检查）呈阳性的患者将被随机分配至两个后续干预组之一。 A.UC（在 Group Health 中包括登记处和医生警报）或 B.护士护理管理（UC + 癌症筛查护士，负责管理阳性检测后的护理。我们的研究假设是：1. SOS 水平的增加将导致 CRCS 率增加，2. 癌症筛查护士的护理管理将增加阳性检测后的随访率。主要具体目标是： 1. 比较每种干预条件对增加 CRCS 率的有效性 2. 比较每种干预条件对筛查测试呈阳性后随访的有效性 次要目标是： 3. 评估每种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 4. 比较每种干预条件的利用率、成本和增量成本效益