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

项目摘要和摘要 结直肠癌(CRC)是美国癌症死亡的第二大原因，它有 对低收入和少数民族人口的影响不成比例。筛查已被证明可以减少 结直肠癌的发病率和死亡率，但实现其全部益处取决于建议的反复筛查 间隔一段时间，或重复测试。年度粪便免疫化学检测(FIT)是一种筛查方式 通常用于低资源的安全网环境，因为访问结肠镜检查存在重大障碍 允许较低频率的筛查。尽管最新的结直肠癌筛查率并不理想 记录在案，对重复匹配或随着时间推移激励匹配完成的多水平因素知之甚少， 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、 以及大型联邦合格健康中心(FQHC)重复匹配的系统级决定因素。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凯撒永久健康公平中心和东北山谷健康公司(NEVHC)，a 大型多地点FQHC，主要为低收入和拉丁裔患者提供护理，人口数量为 CRC筛查未充分利用的最大风险。采用混合方法，我们的具体目标是： (1)评估至少有一个指数匹配的患者在5年内的重复匹配比率和相关性 在多站点FQHC，使用电子病历和管理数据以及基于诊所的扫描和 (2)描述对重复匹配的障碍和促进者以及临床操作经验的看法 对于FIT筛查，使用与患者、提供者和NEVHC工作人员的半结构化定性访谈。 该项目对我们理解低收入、少数族裔的重复匹配有积极的贡献。 在安全网环境中接受护理的少数群体，以及可修改的提供者做法和诊所 程序作为干预目标。研究结果将为制定干预措施提供信息，以改善复发， 指南-低资源临床环境下的一致性匹配筛查。

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.