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

项目总结/摘要 结直肠癌（CRC）筛查可以挽救生命，但在服务不足的人群中，筛查率很低 尤其是拉丁裔。主要由拉丁裔人口提供服务的筛查率 圣伊西德罗健康中心（SYHC，联邦合格的健康中心（SYHC）），只有31%，类似于 这一比例在全国范围内为拉美裔，但低于65%的全国平均水平。先前 研究表明，在医疗护理点（如患者导航）的非接触干预 在筛查后，转诊和常规医疗护理之外的外展（如邮寄邀请）可以 提高服务不足人群的筛查率。然而，由于这些经历有限 在低收入主要是讲西班牙语的拉丁美洲人中进行评估，目前还不清楚哪种方法是 最好的，以及实施这两种方法是否会协同优化筛选率。 我们假设，两种文化和语言定制的干预措施：a）内触策略（IR， 包括社区卫生工作者提供的关于CRC筛查和其他 组成部分），以及B）外展策略（OS，包括邮寄邀请函以完成筛选 通过封闭的粪便免疫化学测试（FIT）和电话提醒）可以大大增加 筛选，并进一步，这两种干预措施在一起将大大优于单独。 为了验证这些假设，我们提出了一项随机试验，比较常规治疗、IR、OS和IR+OS， CRC筛查。拟议的研究是创新的，因为它试图确定矩阵的 在拉丁裔服务不足的人群中优化CRC筛查所需的干预措施是非常可行的， 并有可能对减少服务不足人群的癌症差异产生影响， 包括拉丁裔，在哥伦比亚特区和其他地方服役。该项目符合组织框架， 基于几个方面的合作。首先，它代表了一个假设驱动的研究项目， 来自MCC和SDSU的研究人员一起测试解决癌症差异的策略。二是 该项目有一个社区外展重点，因为工作完全是在一个社区卫生中心内进行的。三是工作量增加 MCC参与与得不到充分服务的人口有关的研究。第四，工作会带来额外的 校外资助申请，以支持癌症差异研究，特别是新的研究人员， 少数民族科学家，如Sheila Castañeda博士（项目共同负责人）。第五，伙伴关系遵循 我们寻求通过以下方式增加CC和ISUPS合作的影响： 我们的工作与联合国儿童基金会合作。

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.