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Implementing multilevel colon cancer screening interventions to reduce rural cancer disparities

实施多层次结肠癌筛查干预措施以减少农村癌症差异

基本信息

批准号：
10658883
负责人：
AIMEE S JAMES
金额：
$ 33.24万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-15 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10658883
关键词：
Address Adult Area Behavioral Sciences Cancer Burden Cancer Control Cancer Etiology Caring Cessation of life Clinic Clinical Clinical Medicine Collaborations Colonoscopy Colorectal Cancer Community Health Systems Computerized Medical Record County Data Diagnostic Early Diagnosis Economics Electronic Health Record Eligibility Determination Epidemiology Evaluation Evidence based intervention Face Fecal occult blood Federally Qualified Health Center Growth Health Personnel Health Service Area Health system Healthcare Healthcare Systems Hot Spot Household Illinois Incidence Intervention Intervention Studies Interview Malignant Neoplasms Measures Medical Medically Underserved Area Mississippi Outcome Outcome Measure Patient Care Patients Population Poverty Primary Care Process Proctor framework Provider Qualitative Methods Randomized Recommendation Records Research Design Research Personnel Resources Rural Rural Community Screening Result Site Surveys Test Result Testing Time Travel United States United States Preventative Services Task Force Universities Washington Work behavior change cancer care cancer health disparity cancer prevention care delivery colon cancer screening colorectal cancer screening design disparity reduction diverse data experience follow-up health care service health care settings health disparity implementation evaluation implementation outcomes implementation science improved intervention effect medical schools medically underserved mortality multidisciplinary patient registry primary care clinic primary care provider primary care setting primary outcome response routine screening rural area rural dwellers rural healthcare rural underserved screening secondary outcome suburb success trial design uptake

项目摘要

PROJECT SUMMARY/ABSTRACT Many rural communities are medically underserved and experience persistently elevated rates of colorectal cancer (CRC) incidence and mortality relative to declining national rates. Routine screening reduces population CRC mortality, yet its impact is reduced because many adults who have an abnormal screening result with fecal testing do not receive diagnostic follow-up with colonoscopy. Rural residents and healthcare providers face unique barriers to screening follow-up including fewer providers who offer colonoscopy and longer travel distances to obtain healthcare. Rural Southern Illinois is a region with high poverty, slow economic growth, isolated households, widely dispersed medical care, and high CRC mortality. To reduce disparities in CRC mortality in rural areas where fecal immunochemical testing (FIT) is a common first-line screening strategy, we must identify effective, sustainable, and disseminable strategies to improve follow-up of positive screening tests. Researchers at Washington University School of Medicine have collaborated with Southern Illinois Healthcare, a rural not-for-profit health system, since 2015 to identify cancer prevention and control priorities and reduce disparities. From 2017 to 2018, we conducted a formal pre-implementation assessment of CRC screening and follow-up processes to identify feasible and promising evidence-based interventions and strategies for improvement. Based on our substantial and specific preliminary data, we propose the following Aims: Aim 1. Implement a multilevel intervention of follow-up of abnormal colon cancer screening tests in primary care clinics across rural Southern Illinois. Using a stepped wedge trial design and cluster randomization, we will implement the multi-level intervention in 18 clinics. We will intervene at three levels (patients, providers/clinical teams, clinics) and evaluate implementation outcomes per Proctor's evaluation model using interviews, surveys, and field notes. Aim 2. Evaluate the impact of the multilevel intervention on follow-up of abnormal screening test results in rural primary care settings in Southern Illinois. Our stepped-wedge design will allow us to test the impact of the multi-level intervention on rates of screening follow-up. We measure outcomes at three levels. Patient: After positive FIT, receipt of referral and completion of colonoscopy. Primary Care Provider: Receipt of positive FIT results and referral for follow-up. Clinic-level: Patients with positive FIT complete colonoscopy. We will assess change in CRC screening rates and investigate interactions between and across levels. Data for primary outcomes will come from the healthcare system's ongoing patient registry that draws from electronic medical records and lab records. The co- construction of this proposal between university researchers and health system stakeholders enhances the potential for significant and sustainable change for effective and efficient screening and early detection. There is a critical need for real-world strategies that can function within rural community health systems to improve health and reduce disparities.

项目总结/文摘