Determinants of Repeat Colorectal Cancer Screening in a Safety-Net System

项目总结和摘要 结直肠癌（CRC）是美国癌症死亡的第二大原因， 对低收入和少数民族人口的影响不成比例。筛选已被证明可以减少 CRC发病率和死亡率，但实现其全部益处取决于推荐的定期筛查。 时间间隔或重复测试。每年粪便免疫化学检测（FIT）是筛查方式 通常用于低资源安全网环境，因为获得结肠镜检查存在重大障碍， 减少筛查频率。尽管最新的CRC筛查的次优率一直很好， 记录，较少了解重复FIT或随着时间的推移激励FIT完成的多层次因素， 特别是在安全网环境中。因此，拟议研究的目的是评估患者、提供者、 和系统水平的决定因素，重复适合在一个大型的联邦合格的健康中心（CIMHC）。这个项目 建立在癌症预防和控制研究中心与 加州大学洛杉矶分校和东北谷健康公司（NEVHC）的Kaiser Permanente健康公平中心 大型多站点的医疗保健中心，主要为低收入和拉丁美洲患者提供护理， CRC筛查利用不足的风险最大。使用混合方法，我们的具体目标是： (1)在至少有一项指数FIT的患者中，评估5年内重复FIT的发生率和相关性 在一个多站点的医疗保健中心，使用电子医疗记录和行政数据以及基于诊所的扫描， (2)描述重复FIT的障碍和促进因素以及临床程序经验的观点 对于FIT筛查，使用与NEVHC的患者，提供者和工作人员的半结构化定性访谈。 本研究对我们了解低收入、少数民族和少数民族的重复散客现象做出了积极的贡献 在安全网环境中接受护理的少数群体，以及可改变的提供者做法和诊所 作为干预目标。调查结果将为制定干预措施提供信息， 在低资源临床环境中进行指南一致的FIT筛查。

PROJECT SUMMARY AND ABSTRACT Colorectal cancer (CRC) is the second leading cause of cancer death in the United States and has a disproportionate impact on low-income and ethnic minority populations. Screening has been shown to reduce CRC incidence and mortality, but realizing its full benefits depends on recurrent screening at recommended intervals over time, or repeat testing. Annual fecal immunochemical testing (FIT) is the screening modality commonly used in low-resource safety net settings, given significant barriers to accessing colonoscopies that allow less frequent screening. Although suboptimal rates of up-to-date CRC screening have been well documented, less is known about repeat FIT or multi-level factors motivating FIT completion over time, particularly in safety-net settings. Therefore, the purpose of the proposed study is to assess patient, provider, and system level determinants of repeat FIT at a large federally qualified health center (FQHC). This project builds on an established partnership between the Center for Cancer Prevention and Control Research and Kaiser Permanente Center for Health Equity at UCLA and Northeast Valley Health Corporation (NEVHC), a large multi-site FQHC that provides care for predominantly low-income and Latino patients, populations at greatest risk for CRC screening underutilization. Using a mixed-methods approach, our specific aims are to: (1) assess rates and correlates of repeat FIT over a 5-year period among patients with at least one index FIT at a multi-site FQHC, using electronic medical record and administrative data and a clinic-based scan and (2) characterize perspectives on barriers and facilitators of repeat FIT and experiences with clinic procedures for FIT screening, using semi-structured qualitative interviews with patients, providers, and staff at NEVHC. This project makes positive contributions to our understanding about repeat FIT among low-income, ethnic minority populations receiving care in safety-net settings, and modifiable provider practices and clinic procedures as intervention targets. Findings will inform the development of interventions to improve recurrent, guideline-concordant FIT screening in low-resource clinical settings.