CRC-HUB-SPOKE: A ColoRectal Cancer screening Hub for Southern California community health centers.

CRC-HUB-SPOKE：南加州社区健康中心的结肠直肠癌筛查中心。

• 批准号: 10689096
• 负责人: Samir Gupta
• 金额: $ 78.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10689096
• 关键词: Acceleration; Address; Adoption; California; Caring; Characteristics; Clinic; Colonoscopy; Colorectal Cancer; County; Data; Data Collection; Data Set; Diagnostic; Early Diagnosis; Education; Environment; Evaluation; Evidence based intervention; Frontline worker; Goals; Health; Health Technology; Incidence; Individual; Infrastructure; Intervention; Interview; Maintenance; Malignant Neoplasms; Measures; Methods; Navigation System; Neighborhood Health Center; Nonprofit Organizations; Outcome; Patients; Phase; Practical Robust Implementation and Sustainability Model; Provider; Public Health Informatics; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Rural; Site; Standardization; System; Test Result; Testing; Underserved Population; United States Preventative Services Task Force; Work; acceptability and feasibility; aged; arm; colorectal cancer prevention; colorectal cancer screening; cost; effectiveness evaluation; electronic health record system; experience; feasibility testing; follow-up; health disparity populations; implementation evaluation; implementation strategy; improved; mortality; outreach; patient navigation; patient oriented; phase 2 study; pilot test; post implementation; pragmatic intervention; pragmatic randomized trial; randomized trial; scale up; screening; technology platform; treatment as usual; uptake

Colorectal cancer (CRC) screening and appropriate follow-up can reduce incidence and mortality. The US Preventive Services Task Force (USPSTF) recommends CRC screening through a variety of invasive and non-invasive tests for individuals aged 50 to 75 years. Evidence-based interventions (EBIs) and other strategies exist to promote CRC screening, but adoption and implementation of these are limited, especially in CHCs. Our hypothesis is that a Hub and Spoke multilevel intervention will be superior to usual care. The hub will be Health Quality Partners of Southern California (HQP), a non-profit organization comprised of 16 CHC systems (spokes), serving 135 rural and urban clinic sites. We propose a 2-phase study to pilot and optimize (Phase I) and rigorously test (Phase II) the Hub and Spoke approach and its impact on CRC screening, follow-up, and usual care. UG3 Planning/Exploratory Phase AIM: Pilot test the feasibility, acceptability, and preliminary outcomes of a multilevel intervention for CRC screening, follow-up, and referral-to-care using a mixed methods approach. The intervention includes HQP hub-based delivery of centralized mailed FIT to patients served by individual CHCs-spokes plus complimentary provider and clinic-level interventions at CHCs, and coordination of a standardized navigation strategy delivered by CHCs for abnormal FIT follow-up. UH3 Implementation Phase. We will conduct a 2-arm pragmatic randomized trial to assess impact of a regionally-developed multilevel intervention to increase CRC screening, follow-up, and referral-to-care among CHC patients. The trial will be guided by the Pragmatic, Robust Implementation and Sustainability Model (PRISM), which includes outcomes from the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and expands them with contextual constructs. Aim 1. Assess effectiveness of the multilevel intervention based on: 1) improvement in proportion up-to-date with screening 3 years post implementation; 2) proportion with abnormal FIT who complete diagnostic colonoscopy within 6 months; and 3) proportion with CRC completing first treatment evaluation. Aim 2. Evaluate the implementation, scalability, and sustainability of a multilevel implementation strategy. Implementation will be evaluated with a mixed methods approach using the RE-AIM outcomes of Reach, Adoption, and Implementation as well as the PRISM constructs of Intervention Characteristics and Recipients from perspective of multiple stakeholders (i.e. patients, front-line staff, and operational leaders). We will also calculate replication costs. Scalability and Sustainability will be evaluated using the RE-AIM outcome of Maintenance and the PRISM constructs of Implementation & Sustainability Infrastructure and External Environment. Our study will help accelerate progress in CRC prevention in underserved populations by identifying multilevel intervention strategies that are scalable to additional CHCs in the region, with potential for larger scale implementation.

结直肠癌（CRC）筛查和适当的随访可以降低发病率和死亡率。美国 预防服务工作组 (USPSTF) 建议通过各种侵入性和非侵入性方法进行 CRC 筛查 针对 50 至 75 岁人群的测试。循证干预措施 (EBI) 和其他策略 存在促进结直肠癌筛查的目的，但这些措施的采用和实施有限，特别是在社区卫生中心。 我们的假设是中心辐射式多层次干预将优于常规护理。该枢纽将是 南加州健康质量合作伙伴 (HQP)，一个由 16 个 CHC 系统组成的非营利组织 （发言人），服务 135 个农村和城市诊所点。我们建议进行两阶段研究来进行试点和优化（第一阶段） 并严格测试（第二阶段）中心辐射方法及其对 CRC 筛查、随访和治疗的影响 平时的护理。 UG3规划/探索阶段目标：试点测试可行性、可接受性和初步 使用混合方法对结直肠癌筛查、随访和转诊进行多层次干预的结果 方法方法。干预措施包括基于 HQP 中心向患者集中邮寄 FIT 由个别 CHC 发言人提供服务，加上 CHC 的免费提供者和诊所级别的干预措施，以及 协调 CHC 针对异常 FIT 后续行动提供的标准化导航策略。尿素3 实施阶段。我们将进行一项 2 臂实用随机试验来评估 区域制定的多层次干预措施，以加强结直肠癌筛查、随访和转诊治疗 CHC 患者中。试验将以务实、稳健的实施和可持续性为指导 模型 (PRISM)，包括范围、有效性、采用、实施的结果， 维护（RE-AIM）框架并通过上下文结构对其进行扩展。目标 1. 评估有效性 多层次干预的依据是：1) 3 年后筛查的最新比例有所改善 执行; 2) 6个月内完成诊断性结肠镜检查的FIT异常的比例；和 3) CRC 完成首次治疗评估的比例。目标 2. 评估实施、可扩展性和 多层次实施战略的可持续性。将使用混合方法评估实施情况 使用 RE-AIM 的覆盖、采用和实施结果以及 PRISM 的方法 从多个利益相关者的角度构建干预特征和接受者（即 患者、一线工作人员和运营领导）。我们还将计算复制成本。可扩展性和 将使用维护的 RE-AIM 结果和 PRISM 结构来评估可持续性 实施和可持续性基础设施和外部环境。我们的研究将有助于加速 通过确定多层次干预策略，在服务不足的人群中预防结直肠癌方面取得进展 可扩展到该地区的其他社区卫生中心，并具有更大规模实施的潜力。

项目成果

Is Promotion of Fecal Immunochemical Testing "FIT" to Address COVID-19 Disruptions to Colorectal Cancer Screening?

• DOI: 10.1053/j.gastro.2021.11.030
• 发表时间: 2022-05
• 期刊: Gastroenterology
• 影响因子: 29.4
• 作者: Trivedi M;Gupta S
• 通讯作者: Gupta S

Hub-and-Spoke centralized intervention to optimize colorectal cancer screening and follow-up: A pragmatic, cluster-randomized controlled trial protocol.

中心辐射型集中干预，以优化结直肠癌筛查和随访：实用的整群随机对照试验方案。

• DOI: 10.1016/j.cct.2023.107353
• 发表时间: 2023
• 期刊: Contemporary clinical trials
• 影响因子: 2.2
• 作者: Castañeda,SheilaF;Gupta,Samir;Nodora,JesseN;Largaespada,Valesca;Roesch,ScottC;Rabin,BorsikaA;Covin,Jennifer;Ortwine,Kristine;Preciado-Hidalgo,Yesenia;Howard,Nicole;Halpern,MichaelT;Martinez,MariaElena
• 通讯作者: Martinez,MariaElena