Screening for Colorectal Cancer: An Integrated Approach

描述（由申请人提供）：结直肠癌筛查程序高度未得到充分利用。我们提出了一个综合的，跨学科的，多层次的方法来理解和增加结肠直肠癌筛查的使用。我们将进行一系列综合目标的研究，以检查谁得到筛查和他们得到什么样的测试，为什么人们不得到筛查，以及什么是最具成本效益的筛查方法。研究结果将有助于开发新的方法，干预措施和政策，以增加筛查和开发新的筛查方法。 具体目标是： (1)检查结直肠癌筛查利用的个人和地区水平预测因素我们将使用来自全国健康访谈调查和医疗支出小组调查的全国代表性数据，我们将链接到提供者/计划和地区水平的数据。我们将特别关注（a）具体卫生计划特点和（B）地区一级特点的影响。 (2)分析患者对结直肠癌筛查方法的偏好我们将使用基于定量和经济理论的方法以及定性方法来测量偏好。我们将特别关注（a）患者对当前和新的筛查测试的各种属性的重视程度;（B）筛查方法的使用如何与对这些方法的偏好相关联;以及（c）医疗保险系统之间和内部的差异如何影响对筛查方法、成本和支付意愿的看法。 (3)进行结直肠癌筛查的成本效益和成本效益分析。 我们将采用先前开发的、经过验证的癌症筛查模型来检查结直肠癌筛查方法的成本效益和净效益。我们将特别关注（a）利用率（目标1）和（B）患者对当前和新筛查方法的偏好（目标2）的影响。

DESCRIPTION (provided by applicant): Colorectal cancer screening procedures are highly underused. We propose an integrated, interdisciplinary, and multi-level approach to understanding and increasing the use of colorectal cancer screening. We will conduct a study with a series of integrated aims to examine who gets screening and what tests they get, why people don't get screening, and what the most cost-effective methods of screening are. The results will be useful in developing new approaches, interventions, and policies to increase screening and in developing new screening methods. Specific aims are to: (1) Examine the Individual and Area-Level Predictors of Colorectal Cancer Screening Utilization We will use nationally representative data from the National Health Interview Survey and Medical Expenditure Panel Survey that we will link to provider/plan and area-level data. We will focus particularly on the impact of (a) specific health plan characteristics and (b) area-level characteristics. (2) Analyze Patient Preferences for Colorectal Cancer Screening Methods We will use a quantitative and economic-theory based approach as well as a qualitative approach to measuring preferences. We will focus particularly on (a) how much patients value the various attributes of current and new screening tests; (b) how utilization of screening methods is associated with preferences for those methods; and (c) how differences across and within health care insurance systems influence perceptions of screening methods, cost, and willingness-to-pay. (3) Conduct Cost-Effectiveness and Cost-Benefit Analyses of Colorectal Cancer Screening. We will adapt a previously developed, validated cancer screening model to examine the cost-effectiveness and net benefits of colorectal cancer screening methods. We will focus particularly on the influence of (a) utilization rates (Aim #1) and (b) patient preferences for current and new screening methods (Aim #2).