Implementing multilevel colon cancer screening interventions to reduce rural cancer disparities

实施多层次结肠癌筛查干预措施以减少农村癌症差异

• 批准号: 9977989
• 负责人: AIMEE S JAMES
• 金额: $ 67.98万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9977989
• 关键词: Address; Adult; Advisory Committees; Area; Behavioral Sciences; Cancer Burden; Cancer Control; Cancer Etiology; Caring; Cessation of life; Clinic; Clinical; Clinical Medicine; Colonoscopy; Colorectal Cancer; Community Health Systems; Computerized Medical Record; County; Data; Diagnostic; Early Diagnosis; Economics; Electronic Health Record; Epidemiology; Evaluation; Evidence based intervention; Face; Fecal occult blood; Federally Qualified Health Center; Growth; Health Personnel; Health Service Area; Health system; Healthcare; Healthcare Systems; Hot Spot; Household; Illinois; Incidence; Intervention; Intervention Studies; Interview; Malignant Neoplasms; Measures; Medical; Medically Underserved Area; Mississippi; Modeling; Outcome; Outcome Measure; Patient Care; Patients; Population; Poverty; Preventive service; Primary Health Care; Process; Process Measure; Provider; Qualitative Methods; Randomized; Records; Research Design; Research Personnel; Resources; Rivers; Rural; Rural Community; Screening Result; Site; Surveys; Test Result; Testing; Time; Travel; United States; Universities; Washington; Work; base; behavior change; cancer care; cancer health disparity; cancer prevention; care delivery; care providers; colon cancer screening; colorectal cancer screening; design; disparity reduction; diverse data; experience; follow-up; health care service; health care settings; health disparity; implementation science; improved; intervention effect; medical schools; medically underserved; mortality; multidisciplinary; patient registry; primary care setting; primary outcome; response; routine screening; rural area; rural dwellers; rural healthcare; rural underserved; screening; secondary outcome; suburb; success; trial design; tv watching; uptake

PROJECT SUMMARY/ABSTRACT Many rural communities are medically underserved and experience persistently elevated rates of colorectal cancer (CRC) incidence and mortality relative to declining national rates. Routine screening reduces population CRC mortality, yet its impact is reduced because many adults who have an abnormal screening result with fecal testing do not receive diagnostic follow-up with colonoscopy. Rural residents and healthcare providers face unique barriers to screening follow-up including fewer providers who offer colonoscopy and longer travel distances to obtain healthcare. Rural Southern Illinois is a region with high poverty, slow economic growth, isolated households, widely dispersed medical care, and high CRC mortality. To reduce disparities in CRC mortality in rural areas where fecal immunochemical testing (FIT) is a common first-line screening strategy, we must identify effective, sustainable, and disseminable strategies to improve follow-up of positive screening tests. Researchers at Washington University School of Medicine have collaborated with Southern Illinois Healthcare, a rural not-for-profit health system, since 2015 to identify cancer prevention and control priorities and reduce disparities. From 2017 to 2018, we conducted a formal pre-implementation assessment of CRC screening and follow-up processes to identify feasible and promising evidence-based interventions and strategies for improvement. Based on our substantial and specific preliminary data, we propose the following Aims: Aim 1. Implement a multilevel intervention of follow-up of abnormal colon cancer screening tests in primary care clinics across rural Southern Illinois. Using a stepped wedge trial design and cluster randomization, we will implement the multi-level intervention in 18 clinics. We will intervene at three levels (patients, providers/clinical teams, clinics) and evaluate implementation outcomes per Proctor's evaluation model using interviews, surveys, and field notes. Aim 2. Evaluate the impact of the multilevel intervention on follow-up of abnormal screening test results in rural primary care settings in Southern Illinois. Our stepped-wedge design will allow us to test the impact of the multi-level intervention on rates of screening follow-up. We measure outcomes at three levels. Patient: After positive FIT, receipt of referral and completion of colonoscopy. Primary Care Provider: Receipt of positive FIT results and referral for follow-up. Clinic-level: Patients with positive FIT complete colonoscopy. We will assess change in CRC screening rates and investigate interactions between and across levels. Data for primary outcomes will come from the healthcare system's ongoing patient registry that draws from electronic medical records and lab records. The co- construction of this proposal between university researchers and health system stakeholders enhances the potential for significant and sustainable change for effective and efficient screening and early detection. There is a critical need for real-world strategies that can function within rural community health systems to improve health and reduce disparities.

项目摘要/摘要 许多农村社区的医疗服务不足，结直肠癌发病率持续上升。 癌症(CRC)发病率和死亡率相对于国家发病率的下降。常规筛查减少人口数量 结直肠癌死亡率，但其影响减少，因为许多成年人有异常的筛查结果与 粪便检测不接受结肠镜检查的诊断性随访。农村居民和医疗保健提供者 面临着独特的筛查后续障碍，包括提供结肠镜检查和更长时间旅行的提供者更少 获得医疗保健的距离。南伊利诺伊州农村是一个贫困程度高、经济增长缓慢的地区， 与世隔绝的家庭，广泛分散的医疗保健，以及较高的儿童死亡率。缩小CRC中的差距 在粪便免疫化学检测(FIT)是常见一线筛查策略的农村地区的死亡率，我们 必须确定有效、可持续和可传播的战略，以改善阳性筛查的后续行动 测试。华盛顿大学医学院的研究人员与南伊利诺伊州合作 Healthcare是一个农村非营利性医疗系统，自2015年以来一直在确定癌症预防和控制的优先事项 并缩小差距。2017年至2018年，我们对CRC进行了正式的实施前评估 筛选和后续进程，以确定可行和有希望的循证干预措施和 改进策略。基于我们大量而具体的初步数据，我们提出如下建议 目的：目的1.实施结肠癌筛查异常随访的多层次干预 在伊利诺伊州南部农村的初级保健诊所。使用阶梯式楔形试验设计和集群 随机化，我们将在18个诊所实施多层次干预。我们将从三个层面进行干预 (患者、提供者/临床团队、诊所)，并根据Proctor的评估评估实施结果 使用访谈、调查和实地笔记进行建模。目的2.评估多层次干预的影响 关于伊利诺伊州南部农村初级保健机构异常筛查测试结果的后续调查。我们的 阶梯式楔形设计将使我们能够测试多水平干预对筛查率的影响 后续行动。我们从三个层面衡量结果。患者：在确定匹配后，收到转诊并完成 结肠镜检查。初级保健提供者：收到阳性匹配结果并转介进行后续治疗。诊所级别： 阳性匹配的患者完成结肠镜检查。我们将评估结直肠癌筛查率的变化，并 调查不同级别之间以及级别之间的交互作用。主要结果的数据将来自医疗保健 系统正在进行的患者登记，从电子医疗记录和实验室记录中提取。联席- 在大学研究人员和卫生系统利益攸关方之间构建这一提案增强了 有可能发生重大和可持续的变化，以便进行有效和高效的筛查和早期发现。那里 迫切需要能够在农村社区卫生系统中发挥作用的现实世界战略，以改善 健康和缩小差距。