Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE): A State-Level Program to Reduce Colorectal Cancer Burden in Vulnerable Populations

通过外展、转诊和参与 (SCORE) 扩大结直肠癌筛查：一项旨在减少弱势群体结直肠癌负担的州级计划

• 批准号: 10693191
• 负责人: Daniel S. Reuland
• 金额: $ 22.62万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10693191
• 关键词: Adoption; African American; American Indians; Appalachian Region; Cancer Burden; Caring; Centers for Population Health; Colonoscopy; Colorectal Cancer; Decision Making; Disparity; Effectiveness; Elements; Evaluation; Evidence based intervention; Face; Goals; Intervention; Intervention Studies; Latino Population; Low Income Population; Measurement; Methods; Modeling; Morbidity - disease rate; Neighborhood Health Center; North Carolina; Outcome; Patient Education; Patients; Phase; Pilot Projects; Play; Population; Process; Program Sustainability; Provider; Randomized, Controlled Trials; Registries; Research; Resource Allocation; Resources; Risk; Role; Site; Standardization; System; Systems Integration; Uninsured; Visit; Vulnerable Populations; burden of illness; cancer health disparity; colorectal cancer screening; community intervention; cost; cost effective; disease disparity; effectiveness/implementation trial; experience; falls; follow-up; implementation evaluation; implementation outcomes; implementation science; improved; innovation; models and simulation; mortality; outreach; patient navigator; pilot test; pragmatic trial; programs; rural area; screening; stakeholder perspectives; vulnerable community

Modified Project Summary/Abstract Section PROJECT SUMMARY Despite strong evidence that colorectal cancer (CRC) screening reduces mortality, rates of CRC screening, follow-up, and referral-to-care (herein referred to as “CRC screening”) remain suboptimal in the US. In North Carolina (NC), underuse of screening contributes to particularly high CRC burden in certain regions. Community health centers (CHCs) play a critical role in providing CRC screening for these vulnerable populations. Yet, CRC screening rates in NC CHCs are well below the estimated national rate of 62%. Substantial efforts are needed to reach the national target of 80%. Because multiple patient-, provider-, and system-level factors contribute to low screening rates, multilevel interventions are needed to achieve screening targets. Accumulating evidence shows that interventions involving mailed screening outreach, practice-based screening in-reach (using patient navigators), and systematically improving colonoscopy access, all increase screening. However, in practice, CHCs face substantial resource limitations and lack the means to systematically implement a multi-level intervention of outreach, in-reach, and improved colonoscopy access for uninsured patients. Until a multi-level intervention is shown to be both effective and cost-effective from stakeholder perspectives, screening rates will remain low, leaving thousands of vulnerable patients at risk. We hypothesize that standardizing these interventions for CHCs at the state-level will yield cost-effective approaches to increasing screening. Our long-term goal is to reduce CRC burden and disparities through improved screening. Our objective here is to leverage our expertise in CRC screening intervention research, implementation science, stakeholder engagement, and modeling to achieve this goal for our state. Our central hypothesis is that a pragmatic trial assessing impacts and costs for combinations of these evidence-based interventions (EBIs) will yield one or more strategies that stakeholders find to be cost-effective and sustainable. The specific aims for our study are: Aim 1 (Planning and Exploratory Phase): Pilot test a multilevel intervention to increase CRC screening in vulnerable populations in three NC regions. In this phase, we will complete pilot studies needed for our signature trial, plan for implementation evaluation and sustainability, and develop a process for evaluating locally-developed innovative approaches for improving screening. Aim 2 (Implementation Phase): Building on Aim 1 findings, implement and evaluate multilevel CRC screening approaches in vulnerable populations in NC. In this phase, we will conduct our signature trial, assess implementation outcomes, evaluate the use of stakeholder-engaged modeling for sustaining and scaling the multilevel intervention, and select and evaluate locally-developed innovations for improving screening. This project is innovative in combining outreach and in-reach EBIs and in its use of stakeholder-engaged simulation modeling to inform sustainability. The proposed research is significant because it will have a substantial impact on CRC morbidity, mortality, and disparities in vulnerable communities.

修改的项目摘要/摘要部分 项目摘要 尽管有充分的证据表明结直肠癌（CRC）筛查降低了死亡率，CRC筛查，随访和转诊至护理的率（此处称为“ CRC筛查”）在美国仍然是最佳的。在北卡罗来纳州（NC），筛查的不足在某些地区造成了特别高的CRC Burnen。社区卫生中心（CHC）在为这些脆弱人群提供CRC筛查方面起着至关重要的作用。但是，NC CHC中的CRC筛查率远低于估计的全国率62％。需要大量努力才能达到80％的国家目标。由于多个患者，提供者和系统级别的因素导致筛查率较低，因此需要进行多级干预以实现筛查目标。积累的证据表明，涉及邮政筛选，基于实践的筛查（使用患者导航器）以及系统地改善结肠镜检查的干预措施，都增加了筛查。但是，实际上，CHC面临着重大的资源限制，缺乏系统地实施对未保险患者的外展，范围内和改善结肠镜检查的多层次干预的手段。从利益相关者的角度来看，在显示多层干预既有效又具有成本效益之前，筛查率将保持较低，使成千上万的脆弱患者处于危险之中。我们假设在状态级别的CHC对CHC进行的这些干预措施将产生成本效益的方法来增加筛查。我们的长期目标是通过改善筛查来减少CRC燃烧和差异。我们的目标是利用我们在CRC筛查干预研究，实施科学，利益相关者的参与和建模方面的专业知识来实现​​我们州的这一目标。我们的核心假设是，一项务实的试验评估了这些基于证据的干预措施（EBIS）的影响和成本，将产生一种或多种策略，利益相关者认为这些策略具有成本效益和可持续性。我们研究的具体目的是：AIM 1（计划和探索阶段）：试点测试多层次干预措施，以增加三个NC地区脆弱人群的CRC筛查。在此阶段，我们将完成我们的签名试验，实施评估和可持续性计划所需的试点研究，以及AIM 2（实施阶段）：在AIM 1基础上建立在NC中脆弱人群中的多级CRC筛选方法。在此阶段，我们将进行签名试验，评估实施结果，评估利益相关者参与者的使用来维持和扩展多层次干预，并选择和评估本地开发的创新以改善筛查。该项目在结合外展和范围的EBI以及使用利益相关者参与模拟建模以为可持续性提供的创新中具有创新性。拟议的研究很重要，因为它将对脆弱社区的CRC发病率，死亡率和差异产生重大影响。