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

帕克兰-UT西南繁荣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络临床提供者网络中的个性化方案来优化结肠癌筛查，为达拉斯大量不同的低保险和无保险患者提供服务。三个相互关联的研究项目将评估与这些弱势群体中过度、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“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，收集包括患者家族风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，比较了促进有效筛查的两种系统级邮寄外展策略的收益、危害和成本：第一种策略从邮寄粪便免疫组织化学检测试剂盒开始；第二种是一封结肠镜检查的邀请函；两者都包括集中流程，以确保基于指导方针的后续工作。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，并检查了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。帕克兰是达拉斯县唯一的安全网提供者，是一个垂直整合的交付系统，包括11个初级保健诊所，照顾32,000名成年人（50-64岁），并有一个全面的电子记录，通过该记录可以确定检查资格，检查订购，结果，转诊和治疗。通过这些功能，筛选过程文件单元将：收集筛选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金星德克萨斯州癌症登记处；促进数据向国家数据协调中心的传输；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.