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

Parkand-UT 西南 PROSPR 中心：安全网中的结肠癌筛查

• 批准号: 8534060
• 负责人: Ethan A Halm
• 金额: $ 112.99万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-23 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8534060
• 关键词: Address; Adult; Appointment; Cancer Center; Caring; Clinic; Clinical; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Commit; Continuity of Patient Care; County; Data; Data Coordinating Center; Disadvantaged; Documentation; Effectiveness; Electronics; Eligibility Determination; Faculty; Goals; Gold; Guidelines; Health; Health system; Hospitals; Human Resources; Immune; Individual; Information Systems; Institution; Integrated Delivery Systems; Lead; Leadership; Link; Low income; Mails; Malignant Neoplasms; Measures; Medical center; Methods; Minority; Outcome; Patients; Policies; Population; Population Heterogeneity; Primary Health Care; Primary Prevention; Procedures; Process; Provider; Public Health Schools; Recording of previous events; Regimen; Research; Research Infrastructure; Research Personnel; Research Project Grants; Resources; Risk Factors; Screening Result; Screening for cancer; Second Primary Cancers; Site; System; Test Result; Testing; Texas; Underinsured; Uninsured; Vulnerable Populations; Work; base; colorectal cancer prevention; colorectal cancer screening; comparative effectiveness; cost; data sharing; effectiveness trial; follow-up; improved; innovation; multidisciplinary; neoplasm registry; outreach; population based; response; safety net; screening; social; success; tool; trial comparing

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.

帕克兰-UT 西南 PROSPR 中心代表了 Parkland 卫生系统、UT 西南医学中心、西蒙斯癌症中心和 UT 公共卫生学院之间充分协调的跨学科合作伙伴关系。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，为达拉斯大量且多样化的保险不足和未投保患者提供服务。三个相互关联的研究项目将评估与这一弱势群体中过度、不足和基于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策略的收益、危害和成本。项目 1 采用“触手可及”策略，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，收集包括患者家族危险因素和结肠镜检查结果在内的信息，以：确定基于指南的个性化筛查方案；描述筛选不足和过度筛选的特征。项目 2 是一项比较有效性试验，比较了两种系统级邮寄外展策略所产生的效益、危害和成本，以促进有效筛查：第一个策略从邮寄粪便免疫组织化学检测试剂盒开始；第一个策略从邮寄粪便免疫组织化学检测试剂盒开始；第二个以邮寄结肠镜检查邀请开始；两者都包括集中流程，以确保基于指南的后续行动。项目 3 描述了网络和诊所层面有助于完成筛查过程的组织因素，并检查哪些组织因素改变了社会劣势与完成基于指南的筛查过程之间的关系。 Parkland 是达拉斯县唯一的安全网提供商，是一个垂直整合的服务系统，包括 11 个初级保健诊所，为 32,000 名成年人（50-64 岁）提供护理，并拥有全面的电子记录，通过该记录可以确定测试资格、测试预约、结果、转诊和治疗。通过这些功能，筛查过程记录部门将： 收集整个筛查过程中所有相关过程和结果的准确、临床详细数据，并链接到 ACCR 金星德克萨斯癌症登记处；促进数据传输至国家数据协调中心；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。