Optimizing Colonscopy & Fecal Immunochemical Tests for Community-Based Screening

优化结肠镜检查

• 批准号: 8791389
• 负责人: DOUGLAS Allen CORLEY
• 金额: $ 65万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-26 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8791389
• 关键词: Address; Adoption; Advanced Malignant Neoplasm; African American; Age-Years; Asia; Asians; Biometry; California; Cancer Center; Cancer Detection; Caring; Cervical Cancer Screening; Cessation of life; Characteristics; Clinical Trials; Collaborations; Colorectal Cancer; Communities; Comorbidity; Complement; Complex; Comprehensive Health Care; Cytology; Data; Data Element; Data Linkages; Data Sources; Detection; Development; Disadvantaged; Discipline of obstetrics; Documentation; Effectiveness; Electronic Health Record; Electronics; Evaluation; Failure; Funding; Goals; Guidelines; Gynecology; HIV; Health; Health Personnel; Health Planning; Health Services; Hispanics; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Immigrant; Incidence; Individual; Infectious Disease Epidemiology; Insurance; Laboratories; Latin America; Lead; Leadership; Learning; Lesion; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Manuscripts; Medicaid; Medical center; Methods; Minority Groups; Modeling; Morbidity - disease rate; Outcome; Pap smear; Pathology; Patients; Pharmacy facility; Physicians; Policies; Population; Prevention; Primary Health Care; Principal Investigator; Process; Provider; Publishing; Recommendation; Research; Research Infrastructure; Research Personnel; Resources; Risk; Schedule; Screening Result; Screening for cancer; Subgroup; System; Techniques; Testing; United States; Vaccinated; Vaccination; Variant; Vision; Woman; Work; anticancer research; base; cancer diagnosis; cancer risk; cancer therapy; cancer type; cervical cancer prevention; clinically relevant; cohort; community setting; comparative effectiveness; computerized data processing; follow-up; health care delivery; high risk; improved; member; mortality; multidisciplinary; oncology; population based; public health priorities; public health relevance; safety net; screening; socioeconomics; uptake

DESCRIPTION (provided by applicant): This application's goal is the creation of a Cervical Cancer Data & Research Unit, within an existing PROSPR Center, that can completely evaluate the cervical cancer screening process and actively engage in PROSPR collaborative projects. Cervical cancer is largely preventable with appropriate screening, yet the implementation of new techniques, such as human papilloma virus (HPV) testing, has created important challenges regarding how to: optimize new screening methods, minimize screening failures by understanding how and why they occur; and diminish overscreening (since, for >99% of women, screening results in only worry and risk). The proposed Unit, within an existing productive PROSPR collaboration of Kaiser Permanente Northern California and Southern California, can address these critical questions using three strengths. 1) A very large community-based cohort with, for the years 2010-2013 alone: >4.8 million screening eligible women; marked demographic diversity (>1,330,000 Hispanic, 589,000 Asian, and 390,000 African American members); detailed screening data (>2.7 million Pap smears, 2.1 million HPV tests, and 600,000 HPV vaccinations); large numbers of rare outcomes (>800 invasive cancers); socioeconomic diversity (including >54,000 with safety-net payors such as Medicaid); health plan and provider diversity (>35 medical centers, >4000 primary care/OB-GYN physicians throughout California); and a full spectrum of high-quality individual cancer risk data within readily accessible electronic laboratory, pharmacy and pathology data sources extending to before 2005. 2) A successful existing PROSPR colorectal cancer center that has been productive within and across the PROSPR network, delivered this year 192 different screening data elements on almost 2.6 million screening-eligible patients, co-led the development of new data elements across PROSPR centers for exam indications and comorbidities and already published high impact PROSPR manuscripts. 3) An expert team in cervical cancer screening, led by two co-Principal Investigators funded in cervical cancer screening research, complemented by a transdisciplinary group of researchers and expert consultants in obstetrics/gynecology, cancer and infectious disease epidemiology, oncology, pathology, modeling, cohort biostatistics, screening quality, and health care delivery. Together, the new Unit can efficiently evaluate the full cervical cancer screening and follow-up - process, put screening actions within the context of comprehensive health care data, and lead PROSPR collaborative studies, such as those described in the Research Plan, that can evaluate the comparative effectiveness of different screening strategies, identify causes of screening failures, and examine the impact of HPV vaccination on screening uptake and outcomes.

描述（由申请人提供）：该申请的目标是在现有的PROSPR中心内创建一个宫颈癌数据和研究单位，该单位可以完全评估宫颈癌筛查过程并积极参与PROSPR合作项目。通过适当的筛查，宫颈癌在很大程度上是可以预防的，但新技术的实施，如人乳头瘤病毒（HPV）检测，在如何优化新的筛查方法，通过了解如何和为什么发生来减少筛查失败方面带来了重要挑战;减少过度筛查（因为，对于>99%的女性来说，筛查只会导致担忧和风险）。在Kaiser Permanente北方加州和南加州的现有生产性PROSPR合作中，拟议的单位可以利用三个优势来解决这些关键问题。1)一个非常大的基于社区的队列，仅在2010-2013年：> 480万符合筛查条件的妇女;显著的人口统计学多样性（> 1，330，000西班牙裔，589，000亚洲人和390，000非洲裔美国人成员）;详细的筛查数据（> 270万巴氏涂片，210万HPV检测，以及2010年的HPV检测）。 60万例HPV疫苗接种）;大量罕见结果（>800种侵袭性癌症）;社会经济多样性（包括> 54，000名医疗补助等安全网支付者）;健康计划和提供者多样性（加州有超过35个医疗中心，超过4000名初级保健/妇产科医生）;以及在2005年之前的电子实验室、药房和病理学数据源中提供的全方位高质量个人癌症风险数据。2)一个成功的现有PROSPR结直肠癌中心在PROSPR网络内部和整个网络中一直富有成效，今年为近260万符合筛查条件的患者提供了192种不同的筛查数据元素，共同领导了PROSPR中心检查适应症和合并症的新数据元素的开发，并已发表了高影响力的PROSPR手稿。3)宫颈癌筛查专家团队，由两名共同主要研究者领导，资助宫颈癌筛查研究，由研究人员和专家顾问组成的跨学科小组补充，包括产科/妇科，癌症和传染病流行病学，肿瘤学，病理学，建模，队列生物统计学，筛查质量和医疗保健服务。新的单位可以一起有效地评估整个宫颈癌筛查和后续过程，将筛查行动纳入综合保健数据的范围，并领导PROSPR合作研究，如研究计划中所述，可以评估不同筛查策略的比较有效性，确定筛查失败的原因， 并检查HPV疫苗接种对筛查摄取和结果的影响。