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

帕克兰-UT西南PROSPR中心代表了帕克兰卫生系统，UT西南医学中心，西蒙斯癌症中心和UT公共卫生学院的全面协调，跨学科的合作伙伴关系。我们的目标是通过我们的综合安全网临床提供者网络中的个性化方案来优化结肠癌筛查，该网络为达拉斯大量不同的低保险和无保险患者群体提供服务。三个相互关联的研究项目将评估临床，系统和组织因素与过度，不足和基于指南的筛查在这个脆弱的人群中，并将比较利益，危害和成本的策略，以促进优化的筛查方案。项目1采用了一种“深入”策略，在初级保健和结肠镜检查诊所实施创新的算法驱动工具，收集包括患者家族风险因素和结肠镜检查结果在内的信息，以：确定个性化的基于指南的筛查方案;表征筛查不足和过度。项目2是一项有效性比较试验，比较了两种系统水平的、用于促进有效筛查的邮寄外展策略的收益、危害和成本：第一种策略始于邮寄粪便免疫组织化学检测试剂盒;第二种策略始于邮寄结肠镜检查邀请;两者都包括集中流程，以确保基于指南的随访。项目3的特点在网络和诊所的水平，有助于完成筛选过程的组织因素，并检查哪些组织因素修改社会劣势和完成基于指南的筛选过程之间的关系。帕克兰是达拉斯县唯一的安全网提供者，是一个垂直整合的提供系统，包括11个初级保健诊所，为32，000名成年人（50-64岁）提供服务，并拥有全面的电子记录，通过该记录可以确定测试，测试订购，结果，转诊和治疗的资格。通过这些能力，筛选过程文件单位将：收集所有相关过程和结果的准确，临床详细的数据在筛选过程中，并链接到ACCR金星得克萨斯州癌症登记;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。

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.