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

项目摘要/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 关于美国人口的儿童权利公约。具体地说，我们的目标是提高结直肠癌筛查率，跟进 通过实施直接邮寄粪便检测，在农村医疗补助患者中进行结肠镜检查和转诊护理 有针对性的外展和患者导航计划，用于后续的结肠镜检查。我们利用 与俄勒冈州农村实践研究网络(ORPRN)合作，凯撒西北 健康研究中心和医疗补助健康计划，并提供培训和实施 利用执业便利化支持参与的农村初级保健诊所。总体而言，我们预计 与30个组织合作，促进130个初级保健诊所的实施 (惠及17,000名农村医疗补助患者)。 在第一阶段(公元01年)，我们会进行一项以里程碑为主导的试验计划，以兴建所需的基础设施，以 大规模实施-有效性试验，包括调整诊所-健康计划-供应商 支持为尚未建立医疗保健和/或从未建立过医疗服务的农村医疗补助患者提供直邮计划 进行初步研究，测试患者导航的可行性和可接受性 支持异常粪便检测后的后续结肠镜检查；参与医疗补助健康计划和 招募位于俄勒冈州农村和边境县的30家初级保健诊所；并开发 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年度)，我们会采用一项准 项目培训与实践在30所农村基层医疗机构中的实验阶梯设计 为支持实施提供便利。正如在试点中一样，干预措施结合了：(1)临床健康计划- 供应商支持直邮粪便检测计划，有针对性地向从未 已进行筛查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，作为主要筛查或来自异常粪便检测的后续检查。我们会 通过定量和定量评估干预的有效性、实施和维护 定性衡量标准。实施研究的结果将为该计划的扩大提供信息 通过与20个为农村/边境初级保健提供服务的区域和国家组织建立伙伴关系 使用在线研讨会、培训员培训讲习班和使用ECHO的协作学习活动的诊所 (社区卫生保健成果推广)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.