(ACCSIS) Accelerating Colorectal Cancer Screening through Implementation Science in Appalachia

修改项目摘要/摘要部分 这个多地点项目旨在增加阿巴拉契亚中部的结直肠癌（CRC）筛查和随访，阿巴拉契亚中部是一个医疗服务不足的地区，被认为是CRC死亡率的三个不同“热点”之一。具体来说，阿巴拉契亚地区委员会将俄亥俄州东部的32个县和肯塔基州东部的54个县分别归类为中北部和阿巴拉契亚中部。该地区的CRC发病率和死亡率是全国最高的，两个州都没有达到80%合格居民接受CRC筛查的国家目标。在该地区，很少有随机干预试验涉及对CRC筛查行为和结局的多水平影响。为了解决这一差距，肯塔基州大学和俄亥俄州州立大学的研究人员将建立12年的合作历史，与阿巴拉契亚社区和卫生诊所的密切关系，以及基于社区的癌症预防和控制干预研究的丰富经验，以开发，实施，并评估多层次干预（MLI）-从循证干预调整而来，包括针对诊所和提供者的部分（in-reach）和社区（outreach）-在肯塔基州和俄亥俄州阿巴拉契亚州的12个县增加50-74岁患者的CRC筛查、随访和从急诊到护理。该项目的总体目标是为MLI提供证据基础，以提高CRC筛查率、随访率和从急诊到护理率，特别是在农村、医疗服务不足的人群中，并帮助展示如何扩大MLI以减轻美国CRC负担的最佳实践。对于第1年的规划探索阶段（UG 3），我们的具体目标是：1）在俄亥俄州阿巴拉契亚州和肯塔基州阿巴拉契亚州进行试点测试、测量和改进MLI，以提高CRC筛查、随访和从急诊到护理的比率;以及2）提供支持过渡到实施阶段（UH 3）的证据[根据NCI批准]。对于第2-5年的实施阶段（UH 4），我们的具体目标是：1）在一项分组随机试验中测试修订后的MLI，延迟干预，以评估MLI对肯塔基州阿巴拉契亚和俄亥俄州阿巴拉契亚人群中CRC筛查率、随访率和从急诊到护理率的影响; 2）评估干预的传播和可持续性。该项目将与12个县的社区和临床合作伙伴合作实施，其中6个在俄亥俄州，6个在肯塔基州。在基线数据收集后，县将被随机分配到早期或延迟干预。主要结果将是美国预防服务工作组指南定义的CRC筛查，并通过诊所电子健康记录和县级行为评估进行测量，使用随机数字拨号电话调查，类似于CDC的行为风险因素监测系统。我们的工作将通过与ACCSIS协调中心，其他ACCSIS研究项目，ACCSIS指导委员会和工作组，NCI和社区合作伙伴的合作来完成。如果有效的话，这个MLI将传播到我们的临床和社区合作伙伴在整个阿巴拉契亚。

Modified Project Summary/Abstract Section This multi-site project aims to increase screening and follow-up for colorectal cancer (CRC) in central Appalachia, a medically underserved region recognized as one of three distinct “hotspots” for CRC mortality. Specifically, the Appalachian Regional Commission classifies 32 eastern Ohio (OH) counties and the 54 counties in eastern Kentucky (KY) as north central and central Appalachia, respectively. CRC incidence and mortality rates in the area are among the highest in the nation, and neither state meets the national target of 80% of eligible residents screened for CRC. There have been few randomized intervention trials addressing multiple levels of influence on CRC screening behaviors and outcomes in this region. To address this gap, investigators at the University of Kentucky and The Ohio State University will build on a 12-year collaborative history, strong relationships with Appalachian communities and health clinics, and extensive experience with community-based cancer prevention and control intervention research to develop, implement, and evaluate a multilevel intervention (MLI) – adapted from evidence-based interventions that include components targeting clinics and providers (in-reach) and the community (outreach) – to increase CRC screening, follow-up and referral-to-care among patients age 50-74 in 12 counties in Appalachian KY and OH. The overall goals of this project are to contribute to the evidence-base for a MLI that increases rates of CRC screening, follow-up, and referral-to-care, particularly in rural, medically underserved populations, and help showcase best practices for how MLIs can be scaled-up to reduce the burden of CRC in the U.S. For the Planning-Exploratory Phase (UG3) in Year 1, our specific aims are to: 1) Pilot test, measure, and refine a MLI to increase rates of CRC screening, follow-up and referral-to-care in Appalachian OH and Appalachian KY; and 2) Provide evidence supporting transition to the Implementation Phase (UH3) [per NCI approval]. For the Implementation Phase (UH4) in Years 2-5, our specific aims are to: 1) Test the revised MLI in a group randomized trial, delayed intervention to assess the impact of the MLI on increasing rates of CRC screening, follow-up, and referral-to-care among Appalachian KY and Appalachian OH populations; and 2) Assess dissemination and sustainability of the intervention. The project will be implemented in collaboration with community and clinical partners in 12 counties, 6 in Ohio and 6 in Kentucky. Counties will be randomized to early or delayed intervention after baseline data collection. The main outcome will be CRC screening as defined by US Preventive Services Task Force guidelines and measured by clinic electronic health records and county- level behavioral assessments using random digit dialed telephone surveys similar to CDC’s Behavioral Risk Factor Surveillance System. Our work will be accomplished through collaboration with the ACCSIS Coordinating Center, other ACCSIS Research Projects, ACCSIS Steering Committee and Workgroups, NCI, and community partners. If effective, this MLI will be disseminated to our clinical and community partners throughout Appalachia.