Increasing Access and Developing Predictors for Colorectal Cancer Screening for Minority and Medicaid Clients

增加少数族裔和医疗补助客户的结直肠癌筛查机会并开发预测因子

• 批准号: 10091591
• 负责人: DEBORAH O ERWIN
• 金额: $ 5.5万
• 依托单位: WITNESS CARES, LLC
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-19 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10091591
• 关键词: Address; Adherence; African American; Assessment tool; Behavior; Behavioral Research; Benchmarking; Businesses; Cancer Control; Caring; Client; Clinical; Colonoscopy; Colorectal Cancer; Community Healthcare; Computers; Contacting Client; Custom; DNA; Data; Death Rate; Development; Disease; Effectiveness; Evaluation; Excision; Feces; Funding; Goals; Gold; Health; Health Care Costs; Health Insurance; Health Personnel; Healthcare; Healthcare Systems; Incidence; Individual; Insurance Carriers; Intervention; Knowledge; Low Income Population; Low income; Malignant Neoplasms; Measures; Medicaid; Medicare; Medicare/Medicaid; Minority; Mission; Modeling; Outcome; Patient Noncompliance; Patients; Persons; Phase; Physicians; Population; Positioning Attribute; Precancerous Polyp; Primary Health Care; Process; Provider; Public Health; Race; Randomized; Reporting; Research; Services; Small Business Technology Transfer Research; Structure; Survival Rate; Testing; Time; Treatment Cost; United States National Institutes of Health; Variant; base; cancer health disparity; cancer prevention; clinical practice; colorectal cancer prevention; colorectal cancer screening; colorectal cancer treatment; commercialization; cost effective; cost effectiveness; disparity reduction; evidence base; experience; improved; innovation; low socioeconomic status; mortality; novel; outreach; phase 1 study; prediction algorithm; predictive modeling; preference; prospective; prototype; public health insurance; racial and ethnic; screening; screening disparities; screening guidelines; service intervention; tailored messaging; technological innovation; therapy development; tool

ABSTRACT African Americans have 22% higher incidence and 49% higher death rates from CRC than any other ethnic/racial group. Similarly, lower socioeconomic status (SES) is also associated with higher CRC incidence and mortality. Both of these groups are overrepresented in Medicaid populations. Screening colonoscopy is a cost-effective cancer prevention and control strategy, leading to CRC prevention (e.g., removal of precancerous polyps), earlier CRC detection and therefore higher survival rates. For patients preferring or needing alternatives, fecal tests are reliable alternatives (e.g., FIT). However, numerous individual and structural barriers often reduce client adherence to screening guidelines resulting in “gaps in care,” increasing costs of treatment and lower quality metrics (e.g., Medicare Star and HEDIS® scores) for the health insurance companies and providers. Insured, non-adherent patients are considered a strategic priority for insurers. The mission of Witness CARES, LLC, is to help improve people's lives by facilitating use of health care. The product to be developed in this STTR Phase I study is a specialized set of services and electronic prototype tool (i.e., WC Services) to optimize and predict CRC screening for Medicaid clients based on our behavioral research, intervention development and delivery through a not-for-profit organization. We will provide personalized, culturally/racially-customized services for insured client end-users while improving national metrics and cost-effective access for the health insurance company and health care provider customers. The technological innovation is development of a computer-based assessment tool (i.e., Screening Engagement Model) allowing us to tailor messaging and type of screening test (FIT or colonoscopy) to client preferences, with the goal of increasing rates of screening for these clients and reducing colonoscopy no-shows for GI facilities. Successful creation of this product will reduce gaps in care for health insurers and reduce disparities in CRC mortality. To move forward, we need to 1) prove that this product can be delivered outside an individual clinical setting and significantly reduce gaps in care; and 2) develop a predictive model for determining which patients are best served by navigation to colonoscopy versus a stool test. The goal of this Phase I application is to prove the feasibility and small scale pilot efficacy of WC Services to increase CRC screening. We propose the following specific aims: Aim 1: Test the feasibility of WC Services to achieve CRC screening for non-adherent Medicaid clients. Milestone 1a: Achieve either colonoscopy or stool screening by a minimum of 130 of 200 (65%) patients contacted. Milestone 1b: Produce a new prototype to test in Phase II. Aim 2: Develop an algorithm for predicting CRC screening outcomes. Milestone 2a: Develop models based on existing R01 data to predict intent and CRC screening behaviors. Milestone 2b: Revise this R01 model with new measures collected prospectively from 80% of clients contacted (n=160) to identify likelihood of stool test v. colonoscopy completion. Milestone 2c: Develop a revised prototype into a complete WC Services product.

摘要 非裔美国人的CRC发病率和死亡率比其他任何人高22%和49% 民族/种族群体。同样，较低的社会经济地位（SES）也与较高的CRC发病率相关 and mortality.这两个群体在医疗补助人群中的比例过高。结肠镜检查是一种 具有成本效益的癌症预防和控制策略，导致CRC预防（例如，去除 癌前息肉），更早的CRC检测，因此更高的生存率。对于喜欢或 需要替代品，粪便测试是可靠的替代品（例如，FIT）。然而，许多个人和 结构性障碍往往会减少客户对筛查指南的遵守，导致“护理差距”， 治疗成本和较低的质量度量（例如，医疗保险星星和HEDIS®分数） 公司和供应商。被保险的非依从性患者被认为是保险公司的战略优先事项。的 见证人关怀有限责任公司的使命是通过促进医疗保健的使用来帮助改善人们的生活。的 在STTR第一阶段研究中开发的产品是一套专门的服务和电子原型 工具（即，WC服务），以优化和预测CRC筛查医疗补助客户的基础上，我们的行为 通过一个非营利组织进行研究、干预措施的开发和交付。我们将提供 为投保客户最终用户提供个性化、文化/种族定制的服务，同时改善国家 为健康保险公司和医疗保健提供者客户提供衡量标准和具有成本效益的访问。的 技术创新是开发基于计算机的评估工具（即，筛选参与 模型），使我们能够根据客户的偏好定制消息传递和筛查测试类型（FIT或结肠镜检查）， 目标是提高这些客户的筛查率，减少GI结肠镜检查的不显示 设施该产品的成功创建将缩小医疗保险公司在护理方面的差距， CRC死亡率。为了向前推进，我们需要1）证明该产品可以在 个人临床环境和显著减少护理差距;和2）开发预测模型， 确定哪些患者最适合导航到结肠镜检查或粪便检查。这个目标 第一阶段的申请是为了证明WC服务在增加CRC方面的可行性和小规模试验效果 筛选我们提出以下具体目标：目标1：测试WC服务实现CRC的可行性 筛查未遵守医疗补助计划的客户。里程碑1a：通过以下方式实现结肠镜检查或粪便筛查： 200例患者中至少有130例（65%）进行了联系。里程碑1b：生产一个新的原型，在第二阶段进行测试。 目标2：开发一种预测CRC筛查结果的算法。里程碑2a：基于以下内容开发模型 现有R 01数据来预测意图和CRC筛查行为。里程碑2b：修订R 01模型， 从80%的联系客户（n=160）中前瞻性收集新指标，以确定粪便检测的可能性 诉结肠镜检查完成。里程碑2c：将修改后的原型开发为完整的WC服务产品。