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）降低结直肠癌死亡率和发病率，然而，40-60%的合格成年人没有在推荐的时间间隔内接受筛查，许多人从未接受过任何类型的CRCS。筛查失败是由于缺乏筛查和对阳性检测结果的随访失败。提高CRCS使用率的战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岁之间的健康组患者，根据国家指南，他们的CRCS不是最新的。在A部分：受试者将随机接受四种逐步增加支持强度的干预措施之一：1.家庭护理（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）。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帮助患者完成选择）。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、评估手术风险、订购测试并协助完成行动计划来管理患者护理）。B部分：FOBT或乙状结肠镜检查（需要结肠镜检查）阳性的患者将随机分配至两个随访干预组之一。A.UC（在Group Health中包括注册表和医生警报）或B.护士护理管理（UC +癌症筛查护士，在阳性检测后管理护理）。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提高阳性检测后的随访率。主要的具体目标是：1。比较每种干预条件对提高CRCS率的有效性2.比较每种干预条件对阳性筛查试验后随访的有效性。次要目的是：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。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