Reducing Disparities in Colorectal Cancer Screening through Proactive Outreach and Navigation in federally qualified health care centers in Brooklyn

通过在布鲁克林联邦合格的医疗保健中心进行主动外展和导航，减少结直肠癌筛查的差异

• 批准号: 10649941
• 负责人: Aasma Shaukat
• 金额: $ 50万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649941
• 关键词: Reducing; Disparities; Colorectal; Cancer; Screening

Colorectal Cancer (CRC) is the third most common cancer in men and women and the second leading cause of cancer related death. Screening for CRC reduces CRC incidence and mortality, and is recommended for average risk men and women between the ages of 45 and 75 by the US Preventive Services Task Force guidelines; which were updated recently to include 45-49 year olds, an additional 20 million individuals in the US. In New York City screening rates are 78% in Manhattan but only 26-55% in federally qualified Health Centers (FQHC) across the city that provide free and subsidized health services to underrepresented minorities. Currently, invitations to screen are offered only when a patient is seen by his or her provider. Consequently, many eligible individuals, particularly 45-55 year olds who do not regularly access healthcare, are under-screened. Hence, there is an unmet need for improving screening practices. We hypothesize that patient care (rates of CRC screening) will improve in under- served populations with the implementation of a proactive approach that incorporates a mailed outreach invitation to screen, followed by active assistance to a colonoscopy completion including overcoming financial and logistical barriers. To address this hypothesis, we seek to improve CRC screening in a hybrid type I trial by assessing the effectiveness and implementation of a proactive outreach colorectal cancer screening program in multiple federally qualified health centers (FQHCs) in Brooklyn, serving primarily Black patients. This proposed work will provide critical, foundational information for scaling up long-term, sustained implementation of screening program across other FQHCs in NYC. We propose to perform a randomized trial of proactive invitation at five FQHCs with aims to study the effect of a proactive outreach program that identifies those due for screening, mail a fecal immunochemical test and provide navigation and financial support for cost of preparation and transport to usual care in improving CRCc screening rates, understand barriers and facilitators to proactive outreach by surveying patients and providers, and perform a cost analysis of the program

结直肠癌（CRC）是男性和女性中第三常见的癌症， 癌症相关死亡的主要原因。筛查CRC可降低CRC发病率， 死亡率，并建议平均风险男性和女性之间的45和75岁 美国预防服务工作队的指导方针;最近更新，包括 45-49奥尔兹，在美国增加了2000万人。在纽约市， 在曼哈顿有78%的人，但在整个曼哈顿地区，只有26-55%的人在联邦合格的健康中心（Health Centers）工作。 这些城市为代表性不足的少数群体提供免费和补贴的医疗服务。目前， 只有当患者被其提供者看到时才提供筛选邀请。 因此，许多符合条件的人，特别是45-55奥尔兹的人， 获得医疗保健，都是筛查不足的。因此，对于改进筛选存在未满足的需求。 实践我们假设，患者护理（CRC筛查率）将在以下情况下得到改善- 服务人群，实施积极主动的方法， 外展邀请进行筛查，然后积极协助完成结肠镜检查 包括克服财政和后勤障碍。为了解决这个问题，我们试图 通过评估有效性改善混合I型试验中的CRC筛查， 在多个联邦州实施积极的外展结直肠癌筛查计划 布鲁克林的合格健康中心（BHHC），主要为黑人患者服务。这一拟议 这项工作将为扩大长期、可持续的 在纽约市其他社区卫生服务中心实施筛查计划。我们建议执行一项 一项在五个社区卫生服务中心进行的主动邀请的随机试验，旨在研究 积极主动的外展计划，确定那些由于筛选，邮寄粪便免疫化学 测试并提供导航和财政支持，以支付准备和运输费用， 关注提高CRCc筛查率，了解积极主动的障碍和促进因素 通过调查患者和提供者进行外展，并对该计划进行成本分析