Community Partnership for Telehealth Solutions to Counter Misinformation and Achieve Equity (PRIME)

摘要 拉丁裔人群癌症筛查服务的使用远远落后于非拉丁裔白人的使用 人口；这导致拉丁裔人的后期检测和更差的存活率。诊所提供的视频- 短信与邻居级导航服务相结合是一种远程医疗社区解决方案，可提供 解决癌症筛查差异的巨大希望，因为它减少了多层次的护理障碍。我们的 拟议的项目，社区远程保健解决方案伙伴关系，以打击虚假信息和 实现公平(Prime)，将利用研究中心、诊所和社区之间的合作伙伴关系 根据当地知识和邻里水平提供个性化支持服务的组织 数据，并应用和评估新的技术和通信解决方案。Prime的目标将是 改善结直肠癌相关护理的提供，并通过以下方式减少远程医疗获取和护理方面的差距 使用新的研究方法开发和测试远程保健工具和技术。这项研究将使用 快速方法和适应性评估进程，并将适用健康公平执行框架 和REACH有效性-采用实施维护(RE-AIM)框架的组成部分，包括 强调在执行和评价方面对差异的影响。Prime将评估邻里层面 健康的社会决定因素，并调整和优化远程医疗解决方案，以提高质量、覆盖范围和 45-54岁拉美裔临床人群中结直肠癌筛查的有效性(目标1)；测试 技术和通信解决方案，使用视频-文本消息教育患者有关结直肠的知识 癌症筛查，将它们链接到基于社区的服务，并提供个性化导航以支持 使用务实的阶梯式楔形设计(12个社区； 3,000名年龄在45-54岁的患者；目标2)；以及评估计划有效性的多级主持人(包括 社区层面的健康、种族和首选语言的社会决定因素)和组织层面 实施的障碍和促进者；以及跨社区和合作伙伴扩大该计划 临床实习地点(n=4；目标3)。该项目将利用当地资源并加强联系 在医疗系统和受信任的社区组织中，增加了计划的可能性 维持性。为了确保项目的成功，我们召集了一个积极参与的社区合作伙伴小组， 包括付款人、健康中心、社区组织和患者，以及多学科 由全国知名临床医生和科学家组成的研究团队。如果成功，该计划将导致 实施减少癌症相关差距的战略，改善预防癌症护理的机会、质量、 以及拉丁裔人口的健康结果。

ABSTRACT Use of cancer screening services for Latinx populations has lagged far behind the use for non-Latinx White populations; this has led to later stage detection and worse survival for Latinx people. Clinic-delivered video- texting combined with neighborhood-level navigation services is a telehealth-community solution that offers great promise for addressing cancer screening disparities, as it reduces multi-level barriers to care. Our proposed project, Community Partnership for Telehealth Solutions to Counter Misinformation and Achieve Equity (PRIME), will leverage partnerships among research centers, clinics, and community organizations to provide personalized support services informed by local knowledge and neighborhood-level data, and apply and evaluate novel technical and communication solutions. The goal of PRIME will be to improve colorectal cancer-related care delivery and reduce disparities in telehealth access and care by developing and testing telehealth tools and technologies using novel research methods. This research will use rapid methods and adaptive-evaluation processes and will apply the Health Equity Implementation Framework and components of the Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) framework, with an emphasis on effects on disparities in implementation and evaluation. PRIME will assess neighborhood-level social determinants of health and adapt and optimize a telehealth-solution to improve the quality, reach, and effectiveness of colorectal cancer screening in predominantly Latinx clinic populations aged 45-54 (Aim 1); test technical and communication solutions that use video-text messages to educate patients about colorectal cancer screening, link them to community-based services, and provide personalized navigation to support to improve uptake of screening and follow-up care, using a pragmatic stepped-wedge design (12 neighborhoods; 3,000 patients aged 45-54; Aim 2); and assess multi-level moderators of program effectiveness (including neighborhood-level social determinants of health, ethnicity, and preferred language) and organizational-level barriers and facilitators to implementation; and scale-up the program across neighborhoods and partnering clinical practice sites (n = 4; Aim 3). This project will leverage local resources and strengthen connections among health systems and trusted community-based organizations, increasing the likelihood of program sustainment. To ensure the project’s success, we have assembled an engaged group of community partners, including payers, health centers, community-based organizations, and patients, along with a multi-disciplinary research team of nationally renowned clinicians and scientists. If successful, the program will result in ready-to- implement strategies to reduce cancer-related disparities and improve preventive cancer care access, quality, and health outcomes for Latinx populations.