Promoting Veteran-Centered Colorectal Cancer Screening

促进以退伍军人为中心的结直肠癌筛查

• 批准号: 8676058
• 负责人: Sameer Dev Saini
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8676058
• 关键词: Accounting; Address; Age; Benefits and Risks; Caring; Clinic Visits; Clinical; Control Groups; Data; Decision Aid; Decision Making; Development; Education; Elements; Equilibrium; Evaluation; Frequencies; Future; Goals; Guidelines; Health; Health Status; Healthcare Systems; Individual; Intervention; Lead; Learning; Life; Measurement; Measures; Methods; Modeling; Modification; Patient Preferences; Patients; Performance; Population; Preventive; Preventive screening; Process; Provider; Randomized Controlled Trials; Reminder Systems; Services; Site; Testing; Veterans; Work; aged; base; colorectal cancer screening; evidence base; group intervention; health administration; improved; operation; preference; primary outcome; screening

Background: Colorectal cancer (CRC) screening is a widely recommended, evidence-based preventive service that has traditionally been underused. Over the last decade, organized efforts by the Veterans Health Administration (VHA) to increase population screening for CRC among Veterans have been successful. But these population-centered efforts have increased screening utilization in a way that is not always concordant with screening benefit, particularly among older Veterans with comorbid illness. As patients get older and acquire health problems, the benefit of screening decreases and the potential harm of screening increases. Yet, existing population-centered efforts fail to adequately inform older, less healthy patients about this changing balance in benefit and harm, often yielding screening utilization that is discordant with benefit. Objectives: (1) to evaluate the impact of a 3-part Veteran-centered intervention (VC) versus pragmatic control (PC) on the frequency of CRC screening orders in a cluster-randomized controlled trial; (2) to perform a process evaluation to identify barriers and facilitators to implementation of Veteran-centered CRC screening as well as any unintended negative effects of our intervention; and, (3) to develop an implementable, Veteran- centered performance measure of CRC screening that incorporates an assessment of the quality of the decision-making process as well as whether or not screening was performed. Methods: We propose a study aimed at promoting more Veteran-centered CRC screening among individuals aged 70-75 with comorbid illness. In Aim 1, we will test a 3-part intervention consisting of: (1) a decision aid to help Veterans make informed screening decisions; (2) education for providers on how the benefits of screening vary according to age and health status; and (3) modification of performance measurement and clinical reminder systems to allow Veterans to make informed decisions about screening (including the informed decision to not be screened). The intervention will be tested in a pragmatic cluster-randomized controlled trial (cluster = provider) at two sites in the VA Ann Arbor Healthcare System. The primary outcome will be whether screening was ordered at the clinic visit. We will also assess the appropriateness of screening orders (i.e., whether screening is ordered in concordance with screening benefit), conceptual understanding of screening, elements of informed decision-making addressed in the screening discussion, and screening utilization at 6 months. In Aim 2, we will perform a process evaluation to inform future implementation efforts. Finally, in Aim 3, we will use the information collected in Aims 1 and 2 and work with an advisory panel of Veterans and an advisory panel of experts and partners from VHA operations to develop a more Veteran-centered performance measure of CRC screening. Impacts: This project will lead to an implementation study of Veteran-centered CRC screening on a broader scale, with the opportunity to measure the effects of such an approach. Furthermore, it will lead to the development of Veteran-centered performance measures that can be tested and potentially extended to other screening and preventive services. Lessons learned from this work may ultimately provide a model for delivering preventive care in a more Veteran-centered way.

背景：结直肠癌（CRC）筛查是一项广泛推荐的循证预防服务 传统上一直未被充分利用。在过去的十年里，退伍军人健康组织的努力 美国卫生部（VHA）在退伍军人中增加CRC人群筛查的努力取得了成功。但 这些以人群为中心的努力以一种并不总是一致的方式提高了筛查的利用率 筛查的好处，特别是在老年退伍军人与共病。随着患者年龄的增长， 随着健康问题的增加，筛查的益处减少，筛查的潜在危害增加。 然而，现有的以人群为中心的努力未能充分告知老年人，不太健康的患者 改变益处和危害的平衡，通常会导致筛查利用与益处不一致。 目的：（1）评价以退伍军人为中心的三部分干预（VC）与务实控制的影响 (PC)在一项随机分组对照试验中，对CRC筛查顺序的频率进行研究;（2）进行一项 过程评估，以确定实施以退伍军人为中心的CRC筛查的障碍和促进因素， 以及我们干预的任何无意的负面影响;（3）制定一个可实施的，退伍军人- 以CRC筛查为中心的性能指标，包括对 决策过程以及是否进行筛选。 方法：我们提出了一项研究，旨在促进更多的退伍军人为中心的CRC筛查的个人 年龄70-75岁，患有共病。在目标1中，我们将测试由三部分组成的干预：（1）决策辅助， 帮助退伍军人做出知情的筛查决定;（2）教育提供者如何从筛查中获益 根据年龄和健康状况而有所不同;和（3）修改性能测量和临床 提醒系统，以使退伍军人作出知情的决定有关筛选（包括知情的 决定不进行筛选）。该干预措施将在一项实用的随机分组对照试验中进行测试 （群集=提供者）在VA安阿伯医疗保健系统的两个站点。主要结果将是 在门诊访视时进行筛查。我们还将评估筛选订单的适当性（即， 筛查是否与筛查获益一致），对筛查的概念性理解， 在筛选讨论中处理的知情决策要素，以及6 个月在目标2中，我们将进行流程评估，为未来的实施工作提供信息。最后，在Aim 3.我们将使用目标1和2中收集的信息，并与退伍军人咨询小组和 来自VHA运营部门的专家和合作伙伴组成的咨询小组，以制定更加以退伍军人为中心的绩效 CRC筛查措施。 影响：该项目将导致一项以退伍军人为中心的CRC筛查的实施研究， 规模，有机会衡量这种方法的效果。此外，这将导致 制定以退伍军人为中心的绩效指标，这些指标可以进行测试，并有可能扩展到其他 筛查和预防服务。从这项工作中吸取的经验教训可能最终为以下方面提供一个模式： 以一种更加以退伍军人为中心的方式提供预防性护理。