RCT/Increase Colon Cancer Screening/Medicaid Managed Care

随机对照试验/增加结肠癌筛查/医疗补助管理护理

• 批准号: 7424925
• 负责人: Allen J. Dietrich
• 金额: $ 49.38万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-27 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7424925
• 关键词: Abbreviations; Advisory Committees; Age; American Cancer Society; Breast; Caring; Characteristics; Clinical; Colon Carcinoma; Colorectal Cancer; Communities; Community Health Centers; Data; Development; Diffusion of Innovation; Disease Management; Effectiveness; Enrollment; Evaluation; Fecal occult blood; Health; Health Maintenance Organizations; Home environment; Intervention; Low income; Malignant neoplasm of cervix uteri; Managed Care; Medicaid; New York City; Nomads; Organizational Models; Outcome; Outcome Measure; Participant; Patients; Prevention; Preventive; Primary Health Care; Process; Randomized; Randomized Controlled Trials; Rate; Recruitment Activity; Research; Research Infrastructure; Research Personnel; Screening procedure; Services; Site; Telephone; Translations; Visit; Woman; Work; base; colorectal cancer screening; cost; cost effectiveness; demographics; improved; outreach; response; theories

DESCRIPTION (provided by applicant): Disparities persist in the colorectal cancer screening. There is need for practical, widely applicable interventions that could correct these disparities. Through previous work (R01-87776) we have developed a Prevention Care Management (PCM) intervention based on telephone support that increased colon cancer screening rates for low income women visiting community/migrant health centers in New York City almost two fold. The earlier project relied on research staff to recruit patients in community/migrant health center (C/MHC) waiting rooms and to provide the intervention, thus, limiting its transportability and sustainability. This new project in response to PAR 04-036 will be based in Medicaid Managed Care Organizations (MMCOs) which can provide sustainable, widely available infrastructures to support colon cancer screening especially for women who comprise a substantial majority of MMCO enrollees. Our first aim is to expand the scope of PCM to apply to MMCO-enrolled women who seldom visit primary care (outreach) while continuing to provide inreach to more frequent attenders. The second aim is to conduct a randomized controlled trial of the expanded PCM intervention to assess its impact on colorectal cancer screening status of low-income women age 50-64 years and to describe the process of Prevention Care Management. Several unique features of the project should be noted: the identification of women overdue for screening through MMCO claims data which is both practical to sustain and expands the reach of the project to include women who seldom visit primary care; the intervention will be delivered by established MMCO staff, not researchers appearing transiently but cannot sustain the intervention; outcomes will be assessed through MMCO claims data; and multiple representative MMCOs in New York City will be involved. Colon cancer screening will be promoted in the context of other indicated screening for breast and cervical cancer. Aim three will explore the relationship of characteristics of the women (demographics), of the community/migrant health centers that serve them, and of the MMCOs in which they are enrolled to colorectal cancer screening status including the impact of the intervention. Cost of the intervention and its relationship to increased screening rates will be assessed. The intervention and evaluation are guided by Diffusion of Innovations.

描述（由申请人提供）： 结直肠癌筛查方面仍然存在差异。需要采取切实可行、广泛适用的干预措施来纠正这些差异。通过之前的工作 (R01-87776)，我们开发了一种基于电话支持的预防护理管理 (PCM) 干预措施，该干预措施将前往纽约市社区/移民健康中心就诊的低收入女性的结肠癌筛查率提高了近两倍。早期的项目依靠研究人员在社区/移民卫生中心（C/MHC）候诊室招募患者并提供干预，从而限制了其可运输性和可持续性。 这个响应 PAR 04-036 的新项目将以医疗补助管理式医疗组织 (MMCO) 为基础，该组织可以提供可持续的、广泛可用的基础设施来支持结肠癌筛查，特别是针对占 MMCO 参与者绝大多数的女性。我们的首要目标是扩大 PCM 的范围，以适用于很少就诊（外展）的 MMCO 注册女性，同时继续向更频繁的就诊者提供深入服务。第二个目标是对扩大的 PCM 干预进行随机对照试验，以评估其对 50-64 岁低收入女性结直肠癌筛查状况的影响，并描述预防护理管理的过程。 应该注意该项目的几个独特之处：通过 MMCO 索赔数据识别逾期筛查的妇女，这既实用又可以维持该项目，并扩大了该项目的覆盖范围，以包括很少去初级保健的妇女；干预措施将由 MMCO 现有工作人员实施，而不是由临时出现但无法维持干预的研究人员实施；结果将通过 MMCO 索赔数据进行评估；纽约市多家具有代表性的MMCO将参与其中。结肠癌筛查将在其他乳腺癌和宫颈癌筛查的背景下得到推广。 目标三将探讨女性特征（人口统计）、为她们服务的社区/移民卫生中心以及她们登记的 MMCO 与结直肠癌筛查状态之间的关系，包括干预的影响。将评估干预的成本及其与筛查率增加的关系。干预和评估以创新扩散为指导。