Optimizing Colorectal Cancer Screening PREcision and Outcomes in CommunIty-baSEd Populations (PRECISE)

优化社区人群的结直肠癌筛查精度和结果 (PRECISE)

• 批准号: 10611337
• 负责人: DOUGLAS Allen CORLEY
• 金额: $ 56.47万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10611337
• 关键词: Address; Adherence; Adult; African American population; Age; Area; Asian Americans; Behavioral Sciences; Cancer Center; Cancer Etiology; Cessation of life; Clinical Trials; Collaborations; Colonoscopy; Colorectal; Colorectal Cancer; Communities; Consultations; Data; Data Collection; Data Element; Data Pooling; Data Set; Deductibles; Detection; Diagnosis; Disparity; Early Diagnosis; Effectiveness; Eligibility Determination; Evaluation; Excision; Failure; Fee-for-Service Plans; Geography; Goals; Guidelines; Health system; Healthcare; Hispanic Populations; Impairment; Incentives; Incidence; Insurance; Intervention; Leadership; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Malignant neoplasm of lung; Manuscripts; Measures; Medicaid; Medicare; Meta-Analysis; Methods; Modality; Modeling; Morbidity - disease rate; NCI Center for Cancer Research; Observational Study; Organ; Outcome; Patients; Pattern; Persons; Physicians; Polypectomy; Polyps; Population; Precancerous Polyp; Process; Productivity; Provider; Publications; Publishing; Recommendation; Research; Resources; Risk; Risk Estimate; Scientist; Screening for cancer; Site; Surveys; System; Testing; United States; Variant; adenoma; age stratification; aged; barrier to care; cancer diagnosis; colon cancer patients; colorectal cancer risk; colorectal cancer screening; demographics; design; disparity reduction; effective intervention; effectiveness testing; follow-up; high risk; human very old age (85+); improved; mortality; older patient; personalized screening; pilot test; population based; preventable death; public health relevance; safety net; screening; screening guidelines; sex; symposium; theories; validation studies

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Most deaths are preventable through early detection, but failures of screening completion and quality substantially impair test effectiveness. This proposal unites the productive PROSPR I CRC Centers into a single collaboration to address key questions and pilot interventions to improve CRC screening outcomes. In PROSPR I, we developed a strong transdisciplinary, multisite collaboration. We collected 316 data elements, performed validation studies, created high-quality pooled data sets to identify patient, provider, and system gaps in the CRC screening process factors and published >60 manuscripts. Our unified PROSPR II Research Center (PRC) will use these proven collaborations and >10 years of longitudinal data for >8.9 million screen-eligible people (~ 1 of 40 eligible people in the US), large numbers of screening exposures (>8.4 million fecal immunochemical tests [FIT] and >1.9 million colonoscopies), and outcomes (>28,000 CRCs). Our PRC is geographically, demographically and economically diverse (three states, >800,000 African Americans, 1.6 million Hispanics, and 1 million Asian Americans). The health systems have different CRC screening patterns, different modalities, and include all major insurance/reimbursement methods (safety net, Medicare, Medicaid, high-deductible and pre-paid/fee-for-service, staff-model and incentivized providers). Our PROSPR I research identified major deficiencies in three areas of CRC screening: who should get screening and surveillance and when; why people do not complete recommended screening, surveillance or follow-up of positive tests; and how test quality and accuracy can be improved. Project 1 will identify on whom and when screening should be performed, particularly for those with conflicting recommendations (e.g., African Americans aged 40-49 years, and patients 76-85 years old). Project 2 will evaluate when surveillance should occur after a precancerous polyp diagnosis, using baseline colonoscopy results and precise new 10-year risk estimates for CRC. Project 3 will explore long-term screening patterns and multilevel drivers of why screening and surveillance are not appropriately completed, especially in understudied patients who never screen, fail to re-screen, use surveillance inappropriately or fail to follow up after a positive screening test. Project 4 will evaluate how to increase the effectiveness of FIT and colonoscopy by optimizing age- and sex-stratified quantitative FIT abnormal ranges, establishing precise adenoma detection thresholds for quality improvement and evaluating drivers of adenoma detection. We will use results from these observational studies, behavioral science methods, and stakeholder involvement to develop and pilot test multilevel interventions. Our transdisciplinary team of scientists, physicians, and healthcare experts will also provide leadership and data for trans-PROSPR, multiple-organ collaborations. The proposed research can substantially decrease the burden of CRC by reducing disparities and identifying ways to improve screening completion and effectiveness.

结直肠癌(CRC)是美国癌症死亡的第二大原因。大多数人的死亡是 通过早期检测可以预防，但筛查完成和质量的失败大大损害了测试 有效性。这项建议将富有成效的PROSPR I CRC中心统一为单一协作，以 解决关键问题和试点干预措施，以改善CRC筛查结果。在PROSPR I中，我们 形成了强大的跨学科、多站点协作。我们收集了316个数据元素，执行了 验证研究，创建了高质量的池化数据集，以确定患者、提供者和系统在 结直肠癌筛查过程因素及已发表的60篇稿件。我们统一的PROSPR II研究中心 (中国)将使用这些经过验证的协作和&gt；10年的纵向数据来获得&gt；890万个符合屏幕条件的数据 人(美国40个符合条件的人中约有1人)，大量筛查暴露(&gt；840万粪便 免疫化学检测[FIT]和190万结肠镜检查)和结果(&gt；28,000个CRC)。我们的中华人民共和国是 地理、人口和经济上的多样性(三个州，80万非裔美国人，1.6 100万西班牙裔美国人和100万亚裔美国人)。卫生系统有不同的CRC筛查模式， 不同的模式，包括所有主要的保险/报销方法(安全网、联邦医疗保险、医疗补助、 高免赔额和预付费/服务费、工作人员模式和激励提供者)。 我们的PROSPR I研究确定了结直肠癌筛查的三个方面的主要缺陷：谁应该接受 筛查和监测以及何时；为什么人们没有完成建议的筛查、监测或 对阳性检测的跟踪；以及如何提高检测质量和准确性。项目1将确定谁在 以及什么时候应该进行筛查，特别是对于那些建议相互矛盾的人(例如，非洲人 美国人年龄40-49岁，患者76-85岁)。项目2将评估监视何时应该 根据基线结肠镜检查结果和精确的新的10年风险，在癌前息肉诊断后发生 对儿童权利公约的估计。项目3将探索长期筛查模式和为什么进行筛查的多层次驱动因素 和监测没有适当完成，特别是在研究不足的患者中，他们从来没有筛查，没有 重新筛查，不适当地使用监测，或在筛查阳性后没有跟进。项目4将 评估如何通过优化年龄和性别分层来提高FIT和结肠镜检查的有效性 定量拟合异常范围，建立精确的腺瘤检测阈值，以提高质量 以及评估腺瘤检测的驱动因素。我们将使用这些观察性研究的结果，行为学 科学的方法，利益相关者的参与，以开发和试点多层次干预措施。我们的 由科学家、医生和医疗保健专家组成的跨学科团队也将为 跨器官移植，多器官合作。建议的研究可以大大减轻负担。 通过减少差距和找出提高筛查完成率和有效性的方法，对儿童权利公约的执行情况进行评估。

项目成果

Post-Colonoscopy Colorectal Cancer Etiologies in a Large Integrated US Health Care Setting.

美国大型综合医疗机构中的结肠镜检查后结直肠癌病因。

• DOI: 10.1053/j.gastro.2022.11.031
• 发表时间: 2023
• 期刊: Gastroenterology
• 影响因子: 29.4
• 作者: Leung,LawrenceJun;Lee,JeffreyK;Merchant,SophieA;Jensen,ChristopherD;Alam,Asim;Corley,DouglasA
• 通讯作者: Corley,DouglasA

Primary Care Provider Beliefs and Recommendations About Colorectal Cancer Screening in Four Healthcare Systems.

• DOI: 10.1158/1940-6207.capr-20-0109
• 发表时间: 2020-11
• 期刊: Cancer prevention research (Philadelphia, Pa.)
• 作者: Ghai NR;Jensen CD;Merchant SA;Schottinger JE;Lee JK;Chubak J;Kamineni A;Halm EA;Skinner CS;Haas JS;Green BB;Cannizzaro NT;Schneider JL;Corley DA
• 通讯作者: Corley DA

Early Screening of African Americans (45-50 Years Old) in a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program.

• DOI: 10.1053/j.gastro.2020.07.011
• 发表时间: 2020-11
• 期刊: Gastroenterology
• 影响因子: 29.4

Index colonoscopy-related risk factors for postcolonoscopy colorectal cancers.

• DOI: 10.1016/j.gie.2018.08.023
• 发表时间: 2019-01
• 期刊: Gastrointestinal endoscopy
• 影响因子: 7.7
• 作者: Tollivoro TA;Jensen CD;Marks AR;Zhao WK;Schottinger JE;Quinn VP;Ghai NR;Zauber AG;Doubeni CA;Levin TR;Fireman B;Quesenberry CP;Corley DA
• 通讯作者: Corley DA

Impact of the COVID-19 Pandemic on Fecal Immunochemical Testing, Colonoscopy Services, and Colorectal Neoplasia Detection in a Large United States Community-based Population.

• DOI: 10.1053/j.gastro.2022.05.014
• 发表时间: 2022-09
• 期刊: Gastroenterology
• 影响因子: 29.4