Evaluating the impact of Basic needs Assessment and Support to Improve Colposcopy Show rate: The BASICS Trial

项目摘要/摘要 每年约有350万人的宫颈筛查结果异常， 推荐用于医学随访，最常见的是阴道镜检查。阴道镜检查使卫生保健提供者能够检测到 并提供可能预防宫颈癌的治疗干预措施。不幸的是，37% 77%的患者在筛查异常后失去了随访机会，从未得到适当的治疗。低 坚持阴道镜检查在黑人患者、低收入人群和个人中尤为普遍 没有保险或有医疗补助的人，导致宫颈癌发病率和 死亡率。我们的初步数据来自两所大学的阴道镜检查诊所，这两家诊所为这些人提供护理 服务不足的患者，显示阴道镜检查依从性在实施A 量身定做的电话干预，提醒患者他们的预约并提供导航帮助 未得到满足的社会需求(如公用事业、交通、食物、住所、衣物、安全)。这些试点数据表明， 社交需求导航员计划提高了阴道镜检查的依从性，但缺乏随机性限制了力度 我们的结论。在这项建议中，我们的目标是测试和评估实施 基于阴道镜检查诊所的社交需求导航器项目重点关注健康的五个社会决定因素： 住房/住所、粮食不安全、个人和邻里安全、经济需求和困境。这个项目 我将检验这样一种假设，即这个关注公平、社会需求导航器的计划可以改进阴道镜检查 服务不足患者的依从性。我们将进行一项随机对照试验，其中72名符合条件 在华盛顿大学转介接受阴道镜检查的患者(低收入、未参保或接受医疗补助) 进入医学院，然后对未得到满足的社会需求和痛苦进行筛选。到那时，他们将成为 按1：1随机分为接受社会需求导航者计划(n=36)或加强日常护理(n=36)。在……里面 领航员手臂是一名社区卫生工作者，将根据他们的需求提供为期四个月的援助。在……里面 增强的日常护理部门，患者将被提供信息和转介到联合之路2-1-1，免费，24小时 全国求助热线，将呼叫者与当地资源联系起来。在具体目标1中，我们将确定我们的 社会需要导航员计划来提高阴道镜检查的依从性。目标2将评估我们的导航员的能力 减少未得到满足的社会需求和痛苦的方案。AIM 3将使用RE-AIM框架来评估指标 执行情况和传播潜力。拟议的工作将提供关键数据，以启动大型、 务实的多点随机对照试验，严格测试有效性、实施和 在不同的患者群体、社区环境、 和医疗保健组织。如果这样的试验表明我们的导航员计划是有效的，成本效益高的，可行的， 而且可以接受，可以广泛实施，以提高宫颈癌患者阴道镜检查的依从性和公平性 预防、发病率和死亡率。

PROJECT SUMMARY/ABSTRACT Each year, approximately 3.5 million individuals have an abnormal cervical screening result and are recommended for medical follow-up, most commonly colposcopy. Colposcopy allows health providers to detect pre-cancers and offer therapeutic interventions that may prevent cervical cancer. Unfortunately, between 37% and 77% of patients are lost to follow-up after their abnormal screen and never receive appropriate care. Low adherence to colposcopy is especially prevalent among Black patients, those with low income, and individuals who are uninsured or have Medicaid, leading to socioeconomic disparities in cervical cancer incidence and mortality. Our preliminary data from two university-based colposcopy clinics that provide care to these underserved patients, show that colposcopy adherence improved from 50% to 83% after implementation of a tailored phone call intervention reminding patients of their appointment and offering navigator assistance with unmet social needs (e.g. utilities, transportation, food, shelter, clothing, safety). These pilot data suggest that a social needs navigator program improves colposcopy adherence, but the lack of randomization limits the strength of our conclusions. In this proposal, our objective is to test, and assess the readiness for implementation of a colposcopy clinic-based social needs navigator program focused on five social determinants of health: housing/shelter, food insecurity, personal and neighborhood safety, financial needs, and distress. This project will test the hypothesis that this equity-focused, social needs navigator program can improve colposcopy adherence among underserved patients. We will perform a randomized controlled trial in which 72 eligible patients (low-income, uninsured, or on Medicaid) who are referred for colposcopy at Washington University School of Medicine, are enrolled and then screened for unmet social needs and distress. They will then be randomized 1:1 into either receive the social needs navigator program (n=36) or enhanced usual care (n=36). In the navigator arm, a community health worker will provide four months of assistance tailored to their needs. In the enhanced usual care arm, patients will be offered information and referral to United Way 2-1-1, a free, 24-hr national helpline that connects callers with local resources. In specific Aim 1 we will determine the efficacy of our social needs navigator program to improve colposcopy adherence. Aim 2 will assess the ability of our navigator program to reduce unmet social needs and distress. Aim 3 will use the RE-AIM framework to evaluate metrics of implementation and potential for dissemination. The proposed work will provide key data to launch a large, pragmatic, multisite randomized controlled trial to rigorously test the effectiveness, implementation, and maintenance of our social needs navigator program across different patient populations, community settings, and healthcare organizations. If such a trial shows that our navigator program is effective, cost-effective, feasible, and acceptable, it can be widely implemented to improve colposcopy adherence and equity in cervical cancer prevention, incidence, and mortality.