IMProving Adherence to Colonoscopy through Teams and Technology (IMPACTT)

项目摘要 基于粪便的结直肠癌筛查异常后的随访结肠镜检查（例如，粪便免疫化学试验 （FIT））导致结直肠癌（CRC）的早期检测、CRC的预防和CRC死亡率的降低。 FIT是一种常用的筛选测试，可以在家中进行，价格低廉，可扩展，并且通常 在结肠镜检查资源稀缺的卫生系统中采用。尽管及时的结肠镜检查 在FIT结果异常后，完成结肠镜检查的患者不到50%， 几个月，并因诊所和卫生系统而异。除了理解一个 FIT异常，患者必须顺利进行三次护理转换：结肠镜转诊，安排， 出席情况.然而，多层面因素影响失访，需要沿着多层面的解决方案 解决损害或延迟结肠镜检查的诊所、提供者和患者层面因素的护理连续体 建成 IMProving坚持结肠镜检查通过团队和技术（IMPACTT），建议缩小差距， 通过提高FIT异常后诊断性结肠镜检查的完成率来减少CRC筛查的差异 在脆弱人群中使用多层次的方法，包括在诊所、提供者和 患者水平。具体目标是：1）评价针对原发性高血压的临床干预效果， 护理提供者和工作人员采用“最佳实践”，以支持异常患者完成结肠镜检查。 FIT结果，2）确定具有增强指示的患者级技术干预的效果 和导航异常FIT患者完成诊断性结肠镜检查，以及3）探索 多层次的实施因素有助于使用混合方法的干预结果。 IMPACTT位于一个公共资助的城市安全网卫生系统中，该系统照顾各种低收入人群， 患者的健康素养和英语水平有限的患病率很高。为了制定解决方案 对于那些特别有可能无法完成随访的脆弱患者，干预措施必须 在为他们服务的环境中进行。此外，鉴于患者健康行为的复杂性和 结肠镜检查完成的多步骤过程，需要可扩展的干预。这一建议是可行的， 因为1）FIT筛查是CRC筛查的标准实践，2）该系统的12个主要 护理诊所与一个胃肠病学实践相结合，3）初级护理和专科护理共享一个 电子健康档案和咨询系统。这些特征为实现提供了基础设施 通过有效的护理协调和沟通促进评估。IMPACTT致力于开发 多层次干预，改善弱势群体的儿童权利委员会后续行动，这有可能减少 其他卫生系统中的卫生差距，并为解决其他卫生问题奠定基础， 行为。

Project Summary Follow-up colonoscopy after abnormal stool-based colorectal cancer screening (e.g., fecal immunochemical test (FIT)) results in early detection of colorectal cancer (CRC), prevention of CRC, and reduction in CRC-mortality. FIT is a commonly utilized screening test that can be performed at home, is inexpensive, scalable, and often adopted in health systems where colonoscopy resources are scarce. Despite evidence that timely colonoscopy is necessary after an abnormal FIT result, completion colonoscopy occurs in less than 50% of patients at 6 months and varies significantly by clinic and health systems. In addition to understanding the meaning of an abnormal FIT, three care transitions must occur smoothly for the patient: colonoscopy referral, scheduling, and attendance. However, multilevel factors influence missed follow-up, and multilevel solutions are needed along the care continuum to address clinic-, provider-, and patient-level factors that impair or delay colonoscopy completion. IMProving Adherence to Colonoscopy through Teams and Technology (IMPACTT), proposes to close gaps and reduce disparities in CRC screening by improving completion of diagnostic colonoscopy following abnormal FIT in vulnerable populations using a multilevel approach consisting of interventions at the clinic-, provider- and patient-level. The specific aims are 1) to evaluate the effect of a clinic-level intervention targeting primary care providers and staff to adopt “best practices” to support colonoscopy completion in patients with abnormal FIT results, 2) to determine the effect of a patient-level technology intervention with enhanced instructions and navigation for patients with abnormal FIT to complete a diagnostic colonoscopy, and 3) to explore the multilevel implementation factors contributing to intervention outcomes using mixed methods. IMPACTT is situated in a publicly-funded, urban safety-net health system that cares for diverse, low-income patients with a high prevalence of limited health literacy and English proficiency. In order to develop solutions that work for vulnerable patients that are at particular risk to incomplete follow-up, interventions must be conducted in the settings that serve them. In addition, given the complexity of patient health behaviors and the multi-step process of colonoscopy completion, scalable interventions are needed. This proposal is feasible in this health system because 1) FIT screening is standard practice for CRC screening, 2) the system’s 12 primary care clinics is integrated with one gastroenterology practice, and 3) primary care and specialty care share an electronic health record and consultation system. These characteristics offer an infrastructure for implementation and evaluation, facilitated by effective care coordination and communication. IMPACTT is positioned to develop a multilevel intervention to improve CRC follow-up for vulnerable populations, which holds the potential to reduce health disparities in other health systems as well as lay the foundation to address other health conditions and behaviors.