Parkand-UT Southwestern PROSPR Center: Colon cancer screening in a safety net

描述(申请人提供)：Parkland-UT西南PROSPR中心：在安全网中进行结肠癌筛查 帕克兰-德克萨斯大学西南PROSPR中心代表着帕克兰卫生系统、德克萨斯大学西南医学中心、西蒙斯癌症中心和德克萨斯大学公共卫生学院之间全面协调的跨学科合作伙伴关系。我们的目标是通过在我们的综合安全网临床提供商网络中通过个性化方案来优化结肠癌筛查，为达拉斯大量和多样化的未参保和未参保患者提供服务。三个相互关联的研究项目将评估与这一弱势人群中基于过度、低于和指南的筛查相关的临床、系统和组织因素，并将比较促进优化筛查方案的战略的好处、危害和成本。项目1通过在初级保健和结肠镜检查诊所实施创新的算法驱动的工具来收集包括患者的家庭风险因素和结肠镜检查结果在内的信息，从而采用“深入”战略：确定基于指南的个性化筛查方案；确定筛查不足和过度的特征。项目2是一项比较有效性试验，比较了两种系统层面的推广战略的效益、危害和成本，以促进有效筛查：第一种战略从邮寄粪便免疫组织化学检测试剂盒开始；第二种战略从邮寄结肠镜检查邀请开始；两种战略都包括确保基于指南的后续行动的集中程序。项目3描述了有助于完成筛查进程的网络和临床一级的组织因素，并审查了哪些组织因素改变了社会劣势与完成以指南为基础的筛查进程之间的关系。Parkland是达拉斯县唯一的安全网提供商，是一个垂直集成的提供系统，包括11个初级保健诊所，为32,000名成年人(50岁-)提供服务，并拥有全面的电子记录，通过该记录可以确定是否有资格接受测试、测试订购、结果、转诊和治疗。通过这些能力，筛查过程文件股将：收集筛查过程中所有相关过程和结果的准确、临床详细的数据，并链接到ACCR Gold-Star德克萨斯癌症登记中心；促进数据传输到国家数据协调中心；并与共享研究资源核心密切合作，提供项目1-3所需的所有数据。

DESCRIPTION (provided by applicant): Parkland-UT Southwestern PROSPR Center: Colon cancer screening in a safety net The Parkland-UT Southwestern PROSPR Center represents a fully coordinated, trans-disciplinary partnership of the Parkland Health System, UT Southwestern Medical Center, Simmons Cancer Center, and UT School of Public Health. Our goal is to optimize colon cancer screening through personalized regimens in our integrated safety-net clinical provider network serving a large and diverse population of under- and uninsured patients in Dallas. Three interlocking research projects will assess clinic, system, and organizational factors associated with over-, under- and guideline-based screening among this vulnerable population, and will compare benefits, harms, and costs of strategies for facilitating optimized screening regimens. Project 1 employs an "in-reach" strategy by implementing innovative, algorithmically driven tools in primary-care and colonoscopy clinics to collect information including patients' familial risk factors and colonoscopy findings to: identify personalized guideline-based screening regimens; characterize under- and over-screening. Project 2, a comparative effectiveness trial, compares benefits, harms and costs resulting from two system level, mailed outreach strategies for promoting effective screening: the first strategy begins with a mailed fecal immune-histochemical test kit; the second begins with a mailed invitation for colonoscopy; both include centralized processes to assure guideline-based follow up. Project 3 characterizes organizational factors at the network and clinic level that contribute to completion of screening processes and examines which organizational factors modify relationships between social disadvantage and completion of guideline-based screening processes. Parkland, the sole safety-net provider in Dallas County, is a vertically integrated delivery system that includes 11 primary care clinics caring for 32,000 adults (50-64 yrs) and has a comprehensive electronic record through which eligibility for a test, test ordering, results, referrals, and treatment are ascertainable. Through these capabilities, the Screening Process Documentation Unit will: collect accurate, clinically detailed data on all relevant processes and outcomes across the screening process, and link to the ACCR Gold-Star Texas Cancer Registry; facilitate data transfers to the national data coordinating center; and work closely with the Shared Research Resources Core to provide all data needed for Projects 1-3.