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: 8631069
• 负责人: Linda K Larkey
• 金额: $ 56.41万
• 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/8631069
• 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; 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; screening; 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.

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，并有助于降低这种癌症引起的发病率和死亡率。尽管最近的一份报告显示结直肠癌筛查测试的使用呈增加趋势，但少数族裔和低收入人群的筛查率仍然不理想。接受结直肠癌筛查转诊是依从性最强的预测因素之一，但对于那些没有诊所或很少去看初级保健提供者的人来说，转诊不太可能，而这些因素在贫困和少数族裔人群中更为常见。我们目前提出的项目旨在以我们团队和其他人建立的证据为基础，测试一种在特别难以接触的人群中传播基于证据的 CRC 筛查推广和协议的方法，其中许多人没有指定“常规”初级保健诊所或提供者。这项两阶段研究的目的是测试使用“社区到诊所导航器”的干预措施的有效性，引导来自特别难以到达、多元文化和保险不足的人群的个人进入初级保健诊所，接受医疗保健提供者转介进行 CRC 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措施对完成 CRC 筛查（第二阶段）的影响。成本效益分析将为进一步评估奠定基础 干预措施的传播政策潜力。目标 1：测试社区团体教育 + 定制导航与仅在提高 50 岁或以上低收入、多文化亚利桑那州居民的就诊率方面的社区团体教育的有效性。对于进行诊所预约的人来说，作为一个单独的关键步骤，我们将使用第一阶段分组作为分析中的控制变量来检查筛查的效果。进行诊所预约的患者将接受基于诊所的导航，这已成为我们几个研究诊所的常规护理。目标 2：追踪第一阶段干预分配对提高门诊患者 CRC 测试完成率的影响。目标 3 和 4 旨在准备将研究结果转化为更广泛的背景。目标 3：确定提高 50 至 75 岁低收入、多文化亚利桑那州居民 CRC 筛查完成率的干预措施各阶段的成本效益。探索性目标 4：使用 RE-AIM 模型检查从社区到诊所到最终筛查的计划传播水平，询问“社区到诊所导航以及诊所到筛查结果的达到、有效性、采用、实施和维护程度如何？”要测试的核心功能是使用定制信息从社区导航到诊所，这是一种新颖的干预措施，初步试点研究表明具有相当大的效果。事实证明，引导患者进行筛查的方案对于实现筛查依从性和降低死亡率是有效的。对于拟议研究的两个步骤，我们都针对现实的社区/诊所环境调整了设计，以实现最大的翻译潜力和最有效实践的成本估算。