Navigation from Community to Clinic to promote CRC Screening in Underserved Popul

从社区到诊所的导航，以促进服务欠缺人群的结直肠癌筛查

• 批准号: 8264314
• 负责人: Linda K Larkey
• 金额: $ 63.99万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8264314
• 关键词: Adherence; Adoption; American; Appointment; Arizona; Breast; Cancer Control; Cancer Etiology; Cervical; Cessation of life; Clinic; Code; Colorectal Cancer; Communities; Community Healthcare; Cost Effectiveness Analysis; Early Diagnosis; Education; Educational Background; Educational Intervention; Effectiveness; Effectiveness of Interventions; Elements; Evaluation; Federally Qualified Health Center; Foundations; Funding; Future; Goals; Health; Health Personnel; Health Priorities; Health Services; Healthcare; Healthcare Systems; Home environment; Individual; Intervention; Low Income Population; Low income; Maintenance; Malignant Neoplasms; Methods; Minority; Modeling; Morbidity - disease rate; Names; National Cancer Institute; Outcome; Participant; Patients; Phase; Pilot Projects; Policies; Population; Primary Health Care; Protocols documentation; Provider; Randomized; Recruitment Activity; Relative (related person); Reporting; Research; Screening procedure; Site; System; Telephone; Testing; Translating; Translations; Underinsured; Uninsured; United States National Institutes of Health; Visit; Work; aged; base; care systems; colorectal cancer screening; community setting; cost; cost effectiveness; design; dissemination research; effective intervention; evidence base; follow-up; implementation research; income insurance; intervention effect; meetings; mortality; novel; programs; response; successful intervention; treatment as usual; trend

DESCRIPTION (provided by applicant): Regular screening facilitates the early diagnosis of colorectal cancer (CRC) and contributes to the reduction of morbidity and mortality this cancer causes. Although a recent report showed an increasing trend in utilization of CRC screening tests, screening rates for minorities and low-income populations remain suboptimal. Having received a referral for CRC screening is one of the strongest predictors of adherence, but referrals are unlikely among those who have no clinic home, or rarely visit a primary care provider, factors that are more common among the poor and minority populations. Our currently proposed project is designed to build upon the evidence established by our team and others to test a method of disseminating evidence-based CRC screening promotion and protocols among a particularly difficult-to-reach population, many of whom do not name a "regular" primary care clinic or provider. The purpose of this two-phase study is to test the effectiveness of an intervention using "community-to-clinic navigators" to guide individuals from an especially hard-to-reach, multicultural and underinsured population into primary care clinics to receive a healthcare provider referral for CRC screening (Phase I) and, subsequently, for those who attend the clinic, to examine the impact of this phase I intervention on completion of CRC screening (Phase II). Cost-effectiveness analysis will lay the foundation for further evaluation of the dissemination policy potential of the intervention. Aim 1: Test effectiveness of community group education + tailored navigation versus community group education only in increasing clinic attendance among low-income, multi-cultural Arizona residents aged 50 or older. As a separate critical step for those who make clinic appointments, we will examine the effect of follow through to screening, using Phase I group assignment as a control variable in analysis. Patients making clinic appointments will receive the clinic-based navigation that has become usual care in several of our study clinics. Aim 2: Track effects of Phase I intervention assignment on increasing CRC test completion among those who attend clinic. Aims 3 and 4 are designed to prepare to translate findings to broader contexts. Aim 3: Determine the cost-effectiveness of each phase of the interventions on increasing CRC screening completion among low-income, multicultural Arizona residents aged 50 to 75 years. Exploratory Aim 4: Examine the levels of program dissemination from community to clinic to final screenings using the RE-AIM model, asking, "What is the degree of Reach, Efficacy, Adoption, Implementation, and Maintenance of the community-to-clinic navigation, and clinic-to-screening outcomes?" The central feature to be tested, navigation from community to clinic using tailored messages, is a novel intervention, shown in an initial pilot study to have a sizeable effect. The protocols in plae to navigate patients to screening have been shown to be effective for achieving screening adherence and reducing mortality. For both steps of the proposed research, we have adapted the design for realistic community/clinic contexts for maximum translation potential and cost estimates for most effective practices. PUBLIC HEALTH RELEVANCE: Regular screening facilitates the early diagnosis of colorectal cancer (CRC), the second leading cause of cancer death, and contributes to the reduction of CRC morbidity and mortality, but the hardest-to-reach patients are still under-screened. This study will merge and incorporate two primary elements of successful interventions tested by the co-PIs to examine dissemination outcomes; we will test effects of "community-to- clinic navigators" using a tailored navigation protocol to guide individuals from an especially hard-to-reach, multicultural, and underinsured population into primary care clinics and, subsequently, track the effects of this intervention through a clinic navigation program to complete CRC screening. A cost-effectiveness analysis will lay the foundation for further implementation and dissemination research.

描述(由申请人提供)：定期筛查有助于结直肠癌(CRC)的早期诊断，并有助于减少这种癌症造成的发病率和死亡率。尽管最近的一份报告显示，CRC筛查测试的使用率有增加的趋势，但少数民族和低收入人口的筛查率仍然不是最理想的。接受结直肠癌筛查的转介是遵守的最有力的预测因素之一，但对于那些没有诊所或很少去初级保健提供者的人来说，转介是不太可能的，这些因素在穷人和少数族裔人口中更常见。我们目前提议的项目旨在建立在我们团队和其他人建立的证据的基础上，以测试一种在特别难以接触到的人群中传播基于证据的CRC筛查宣传和方案的方法，这些人群中的许多人没有说出“定期”初级保健诊所或提供者的名字。这项分两个阶段进行的研究旨在测试使用“社区到诊所导航器”的干预措施的有效性，以引导个人从特别难以接触到的、多元文化和保险不足的人群进入初级保健诊所，接受卫生保健提供者转介进行结直肠癌筛查(第一阶段)，随后，对于那些到诊所就诊的人，检查这一第一阶段干预对完成结直肠癌筛查(第二阶段)的影响。成本效益分析将为进一步评估 干预的传播政策潜力。目标1：测试社区小组教育+定制导航与社区小组教育仅在50岁或以上的低收入、多元文化的亚利桑那州居民增加诊所就诊率方面的有效性。对于那些预约诊所的人来说，作为一个单独的关键步骤，我们将使用第一阶段小组分配作为分析中的控制变量，检查跟踪到筛查的效果。预约诊所的患者将获得基于诊所的导航，这已成为我们几个研究诊所的常规护理。目的2：追踪第一阶段干预任务对提高就诊者结直肠癌检测完成率的影响。目标3和目标4旨在为将调查结果转化为更广泛的背景做准备。目的3：确定在亚利桑那州50至75岁的低收入、多元文化居民中提高结直肠癌筛查完成率的干预措施的每个阶段的成本效益。探索性目标4：使用RE-AIM模型检查从社区到诊所再到最终筛查的项目传播水平，询问“社区到诊所导航和诊所到筛查结果的覆盖程度、有效性、采用、实施和维护情况如何？”要测试的中心功能是使用定制消息从社区导航到诊所，这是一种新颖的干预措施，在最初的试点研究中显示出了相当大的效果。PLEA中引导患者进行筛查的方案已被证明在实现筛查依从性和降低死亡率方面是有效的。对于拟议研究的这两个步骤，我们调整了针对现实社区/诊所背景的设计，以实现最大的翻译潜力和最有效实践的成本估计。 公共卫生相关性：定期筛查有助于结直肠癌(CRC)的早期诊断，结直肠癌是癌症死亡的第二大原因，有助于降低结直肠癌的发病率和死亡率，但最难接触到的患者仍然没有得到充分的筛查。这项研究将合并和纳入由联合PIS测试的成功干预措施的两个主要要素，以检查传播结果；我们将使用定制的导航协议测试“社区到诊所导航员”的效果，以引导来自特别难以到达的、多元文化和保险不足人群的个人进入初级保健诊所，并随后通过诊所导航计划跟踪这一干预措施的效果，以完成CRC筛查。成本效益分析将为进一步执行和传播研究奠定基础。