Project 2: A randomized trial of outreach and inreach strategies for boosting colorectal cancer screening in a Federally-Qualified Health Center primarily serving low income Hispanic/Latinos

项目 2：在主要为低收入西班牙裔/拉丁美洲人服务的联邦合格健康中心进行外展和内展策略的随机试验，以促进结直肠癌筛查

• 批准号: 9349472
• 负责人: Samir Gupta
• 金额: $ 22.75万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-26 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9349472
• 关键词: Address; Advisory Committees; Affordable Care Act; Applications Grants; Cancer Center; Caring; Centers for Disease Control and Prevention (U.S.); Client; Clinic; Collaborations; Colorectal Cancer; Communities; Community Health Aides; Community Health Centers; Community Outreach; Complement; Comprehensive Cancer Center; Cost Sharing; County; Education; Effectiveness; Effectiveness of Interventions; Environment; Evaluation; Evidence based intervention; Extramural Activities; Face; Federally Qualified Health Center; Health; Health Insurance; Hispanics; Individual; Intervention; Latino; Lead; Linguistics; Low income; Medicaid; Medical; Mexico; Minority; Modeling; National Cancer Institute; Outcome; Patients; Physicians; Population; Positioning Attribute; Preventive service; Primary Health Care; Process; Provider; Randomized Controlled Trials; Recommendation; Recording of previous events; Reporting; Research; Research Personnel; Research Project Grants; Resources; Screening for cancer; Services; Telephone; Testing; Time; Underinsured; Underserved Population; Uninsured; Universities; Work; Workplace; base; cancer health disparity; care delivery; colorectal cancer screening; community partnership; compare effectiveness; ethnic minority population; evidence base; follow-up; innovation; intervention effect; minority scientist; mortality; outreach; racial and ethnic; randomized trial; satisfaction; screening; treatment as usual; trial comparing

PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) screening saves lives, but screening rates are low among underserved populations, particularly Latinos. The screening rate in the predominantly Latino population served by San Ysidro Health Center (SYHC, a Federally Qualified Health Center (FQHC)), is just 31%, similar to that reported for Latinos nationally, but lower than the overall national average of 65%. Previous research has demonstrated that inreach interventions at point of medical care such as patient navigation after screening referral, and outreach outside of usual medical care (such as with mailed invitations) can increase screening rates among underserved populations. However, since these have undergone limited evaluation among low income predominantly Spanish-speaking Latinos, it is unclear which approach is best, and whether implementing both approaches would be synergistic for optimizing screening rates. We hypothesize that two culturally and linguistically tailored interventions: a) an inreach strategy (IR, consisting of community health worker-delivered in clinic education regarding CRC screening and other components), and b) an outreach strategy (OS, consisting of mailed invitations to complete screening with an enclosed fecal immunochemical test (FIT) and telephone reminders) can substantially increase screening, and further, that the two interventions together will be substantially better than either alone. To test these hypotheses, we propose a randomized trial comparing usual care, IR, OS, and IR+OS for CRC screening. The proposed research is innovative because it seeks to identify the matrix of interventions required to optimize CRC screening in a Latino underserved population, is highly feasible, and has potential to be impactful for reducing cancer disparities among underserved populations, including Latinos, served at FQHCs and beyond. This project fits within the organizing framework of the partnership based on several aspects. First, it represents a hypothesis-driven research project that brings together investigators from MCC and SDSU to test strategies for addressing cancer disparities. Second, the project has a community outreach focus, as the work is entirely set within a FQHC. Third, the work increases involvement of MCC in research related to underserved populations. Fourth, the work will result in additional extramural grant applications to support cancer disparities research, particularly by new investigators who are minority scientists, such as Dr. Sheila Castañeda (Project Co-Lead). Fifth, the partnership follows the model of the Outreach Core, in which we seek to increase the impact of CC and ISUPSs collaborations by partnering our work with FQHCs.

项目概要/摘要 结直肠癌 (CRC) 筛查可挽救生命，但服务水平低下的人群筛查率较低 人口，特别是拉丁裔。服务于拉丁裔人口的筛查率 圣伊西德罗健康中心（SYHC，联邦合格健康中心 (FQHC)）的比例仅为 31%，与 全国拉丁裔的比例，但低于全国 65% 的总体平均水平。以前的 研究表明，医疗护理点的触及干预措施（例如患者导航） 筛选转诊后，以及常规医疗护理之外的外展活动（例如邮寄邀请函）可以 提高服务不足人群的筛查率。然而，由于这些都受到了有限的 在对低收入人群（主要是讲西班牙语的拉丁裔）进行评估时，尚不清楚哪种方法更适合 最好，以及实施这两种方法是否可以协同优化筛查率。 我们假设有两种根据文化和语言量身定制的干预措施：a) 深入战略（IR、 由社区卫生工作者组成，提供有关 CRC 筛查和其他方面的临床教育 b) 外展策略（OS，包括完成筛选的邮寄邀请 通过封闭的粪便免疫化学测试（FIT）和电话提醒）可以显着增加 筛选，并进一步证明两种干预措施一起使用会比单独使用任何一种干预措施要好得多。 为了检验这些假设，我们提出了一项随机试验，比较常规护理、IR、OS 和 IR+OS 的治疗效果 结直肠癌筛查。拟议的研究具有创新性，因为它试图确定矩阵 在服务不足的拉丁裔人群中优化 CRC 筛查所需的干预措施是高度可行的， 并有可能对减少服务不足人群的癌症差异产生影响， 包括拉丁美洲人，曾在 FQHC 及其他机构任职。该项目符合该组织的组织框架 伙伴关系基于几个方面。首先，它代表了一个假设驱动的研究项目，它带来了 来自 MCC 和 SDSU 的研究人员一起测试解决癌症差异的策略。其次， 该项目以社区外展为重点，因为工作完全在 FQHC 内进行。三、工作量增加 MCC 参与与服务不足人群相关的研究。第四，这项工作将带来额外的成果 支持癌症差异研究的校外拨款申请，特别是新研究人员的研究 是少数族裔科学家，例如 Sheila Castañeda 博士（项目联合负责人）。五、合作伙伴关系遵循 Outreach Core 模型，其中我们寻求通过以下方式增加 CC 和 ISUPS 合作的影响： 与 FQHC 合作开展工作。