Screening More patients for CRC through Adapting and Refining Targeted Evidence-based Interventions in Rural settings (SMARTER CRC)

项目总结/摘要： 这个分两个阶段的项目旨在通过减轻负担来实现癌症登月目标 对美国人口的影响。具体来说，我们的目标是提高CRC筛查率， 结肠镜检查，并通过实施直接邮寄粪便检测在农村医疗补助患者转诊护理 计划有针对性的推广和患者导航的后续结肠镜检查。我们利用 与俄勒冈州农村实践为基础的研究网络（ORPRN），凯撒西北合作伙伴关系 健康研究中心和Medicaid健康计划，并提供培训和实施 支持参与的农村初级保健诊所使用实践促进。总的来说，我们预计 与30个组织合作，促进130个初级保健诊所的实施 （覆盖17,000多名农村医疗补助患者）。 在第一阶段（二零零一年），我们会进行一项里程碑式的试验计划， 大规模实施效果试验，包括调整诊所-健康计划-供应商 为尚未建立护理和/或从未建立护理的农村医疗补助患者提供支持的直邮计划 进行了筛选;进行了一项试点研究，测试患者导航的可行性和可接受性， 支持粪便检测异常后的后续结肠镜检查;参与医疗补助健康计划并 在俄勒冈州的农村和边境县招募30个初级保健诊所; 在这些环境中实施大规模试验所需的培训和支持材料。 在第二阶段（02-05年），我们将使用一个准 在30个农村初级保健诊所使用程序培训和实践的实验性阶梯楔形设计 促进支持实施。与试点一样，干预措施结合了：（1）诊所健康计划- 供应商支持的直邮粪便检测计划，针对从未 已筛选或尚未建立护理的患者，以及（2）转诊患者的患者导航 用于结肠镜检查作为主要筛查或用于异常粪便试验的随访。我们将 通过定量和定性的方法， 质量措施。执行研究的结果将为扩大方案提供信息 通过与20个为农村/边境初级保健服务的区域和国家组织建立伙伴关系， 诊所使用网络研讨会、培训培训师研讨会和使用ECHO的协作学习活动 （社区卫生保健成果扩展）模式。

PROJECT SUMMARY/ABSTRACT: This two-phase project is designed to achieve the Cancer Moonshot objectives by reducing the burden of CRC on the US population. Specifically, we aim to improve CRC screening rates, follow-up colonoscopy, and referral to care in rural Medicaid patients by implementing a direct mail fecal testing program with targeted outreach and patient navigation for follow-up colonoscopy. We leverage partnerships with the Oregon Rural Practice-based Research Network (ORPRN), Kaiser Northwest Center for Health Research, and Medicaid Health Plans and deliver training and implementation support to participating rural primary care clinics using practice facilitation. In total, we anticipate working with 30 organizations to facilitate implementation with 130 primary care clinics (reaching 17,000+ rural Medicaid patients). In Phase I (Year 01), we will conduct a milestone driven pilot to build the necessary infrastructure for a large-scale implementation-effectiveness trial, including adapting the clinic-health plan-vendor supported direct mail program for rural Medicaid patients that have not established care and/or never been screened; conducting a pilot study testing the feasibility and acceptability of patient navigation to support follow-up colonoscopy following an abnormal fecal test; engaging Medicaid Health Plans and recruiting 30 primary care clinics located in rural and frontier counties in Oregon; and developing the training and support materials needed to implement a large-scale trial in these settings. In Phase II (Years 02-05), we will conduct an implementation-effectiveness study using a quasi- experimental stepped wedge design in 30 rural primary care clinics using program training and practice facilitation to support implementation. As in the pilot, the intervention combines: (1) a clinic-health plan- vendor supported direct-mail fecal testing program with targeted outreach for patients who have never been screened or who have yet to establish care and (2) patient navigation for those who are referred for colonoscopy as either the primary screening or for follow-up from an abnormal fecal test. We will evaluate effectiveness, implementation, and maintenance of the intervention through quantitative and qualitative measures. Results from the implementation study will inform scale-up of the program through partnerships with 20 regional and national organizations that serve rural/frontier primary care clinics using webinars, train-the-trainer workshops and collaborative learning activities using the ECHO (Extension for Community Healthcare Outcomes) model.