Increasing Colorectal Cancer Screening Rates in Community Health Centers

描述（由申请人提供）：社区卫生中心（CHCs）没有办公室系统来确保每个符合条件的患者都能接受结直肠癌（CRC）筛查。社区中心需要基于证据的方法来实施办公室系统变革，并考虑到它们所面临的大量资源、人员配备和时间限制。在这一需求得到满足之前，筛查率可能会保持在较低水平，使成千上万的少数民族、低收入和没有保险的患者面临不必要的风险。长期目标是提高CHCs的CRC筛查率，并以此减少癌症健康差距。本R21应用程序的目的是测试将办公系统工具包和外展教育相结合的循证实施策略的可行性。该项目的基本原理得到了初步数据的支持，即卫生保健中心希望提高CRC筛查率，但需要基于证据的工具，通过培训和技术援助，它们可以更高效地实施和维护这些工具。虽然拟议的实施策略是有证据依据的，而且很有希望，但在CHC环境中它是新颖的，需要在这种具有挑战性的组织环境中进行可行性测试，然后再进行大规模评估。本研究将追求三个具体目标：(1)利用CRC工具包和外展专家评估促进CRC筛查的办公系统变革的实施程度；(2)使用CRC工具包和外联专家估算实施和维护办公系统变更的成本；(3)使用CRC工具包和外联专家，对实施的办公系统改革进行有限的测试。第一个目的是，通过创新实施的概念模型进行访谈和调查，以检查CHCs实施的办公系统工具的数量和类型，所提供的外展支持的数量和类型，以及预测实施有效性的组织因素。对于第二个目标，将使用流程图、活动日志和单价来估计实施CRC筛选过程变更的成本，并通过比较实施前后CRC筛选过程的成本和收入来计算净效益。对于第三个目标，将通过实施前后的图表审计来评估记录在案的医生推荐筛查和完成筛查的变化。这个项目的创新之处在于，它试图将目前在chc中进行基于系统的变革的范例从质量改进协作方法转变为在chc资源受限的情况下承诺更大可行性的方法。拟议的研究具有重要意义，因为它有可能通过提高少数民族、低收入和保险人群的CRC筛查率来改善公众健康，并对办公室系统方法如何工作的科学知识做出贡献。

DESCRIPTION (provided by applicant): Community health centers (CHCs) do not have the office systems in place to ensure that every eligible patient is offered colorectal cancer (CRC) screening. CHCs need evidence-based approaches to implementing office- system changes that take into account the substantial resource, staffing, and time constraints they face. Until this need is met, screening rates will likely remain low, putting thousands of minority, low-income, and uninsured patients at unnecessary risk. The long-term goal is to improve CRC screening rates in CHCs and in doing so, reduce cancer health disparities. The objective of this R21 application is to test the feasibility of an evidence-informed implementation strategy that combines an office-systems toolkit and outreach education. The rationale for the project, supported by preliminary data, is that CHCs want to increase CRC screening rates, but need evidence-based tools that-with training and technical assistance-they can implement and maintain more efficiently and effectively. Although the proposed implementation strategy is evidence-informed and promising, it is novel in the CHC setting and needs to be feasibility-tested in this challenging organizational context prior to larger-scale evaluation. This research study will pursue three specific aims: (1) assess the extent of implementation of office-system changes that promote CRC screening, using the CRC toolkit and outreach specialist; (2) estimate the costs of implementing and maintaining office-system changes, using the CRC toolkit and outreach specialist; (3) conduct a limited test of the office-system changes implemented, using the CRC toolkit and outreach specialist. For the first aim, interviews and surveys informed by a conceptual model of innovation implementation will be used to examine the number and type of office-system tools that CHCs implement, the amount and type of outreach support provided, and organizational factors predictive of implementation effectiveness. For the second aim, process maps, activity logs, and unit prices will be used to estimate the cost of implementing changes to the CRC screening process and calculate net benefit by comparing the costs and revenues of CRC screening processes pre- and post-implementation. For the third aim, changes in documented physician recommendation for screening and completed screenings will be assessed through chart audits pre- and post-implementation. This project is innovative in that it attempts to shift the current paradigm for making systems-based changes in CHCs from the quality improvement collaborative approach to one that promises greater feasibility given CHCs' resource constraints. The proposed research is significant because of its potential to improve public health by increasing CRC screening rates in minority, low income and insured populations and its contribution to scientific knowledge about how the office- systems approach works.