IMProving Adherence to Colonoscopy through Teams and Technology (IMPACTT)

项目摘要 粪便异常结直肠癌筛查(如粪便免疫化学检测)后的随访 (Fit))有助于及早发现结直肠癌、预防结直肠癌并降低结直肠癌死亡率。 FIT是一种常用的筛查测试，可以在家中进行，价格低廉，可扩展，而且通常 在结肠镜检查资源稀缺的卫生系统中采用。尽管有证据表明及时的结肠镜检查 在异常匹配结果后是必需的，不到50%的患者在6点进行完全结肠镜检查 几个月，并因诊所和卫生系统的不同而有很大差异。除了理解一种 异常匹配，患者必须平稳地进行三个护理过渡：结肠镜检查转诊、日程安排和 出席率。然而，多层次的因素会影响遗漏的随访，因此需要多层次的解决方案 护理连续体，以解决损害或延迟结肠镜检查的临床、提供者和患者层面的因素 完成了。 通过团队和技术(Impactt)提高对结肠镜检查的坚持，建议弥合差距和 通过改善异常配合后结肠镜检查的完成率来减少结直肠癌筛查中的差异 在弱势人群中使用多级方法，包括在诊所、提供者和 病人级别的。具体目标是：1)评估针对初发疾病的临床水平干预措施的效果 护理人员和工作人员将采用“最佳实践”来支持异常患者的结肠镜检查 符合结果，2)确定具有增强说明的患者级技术干预的效果 和导航配合异常的患者完成诊断性结肠镜检查，3)探索 使用混合方法的多层次实施因素对干预结果的影响。 Impactt位于一个由公共资金资助的城市安全网医疗系统中，该系统照顾多样化的低收入人群。 患病率高的患者健康素养和英语水平有限。为了开发解决方案 对于特别有可能获得不完全随访的脆弱患者，干预措施必须是 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 完成结肠镜检查的多步骤过程，需要可扩展的干预措施。这项建议在以下方面是可行的 这个卫生系统是因为1)适合筛查是CRC筛查的标准做法，2)系统的12个主要部分 保健诊所与一个胃肠病学诊所整合在一起，3)初级保健和专科护理共享一个 电子健康档案和会诊系统。这些特征为实施提供了基础设施 和评估，通过有效的护理协调和沟通促进。Impactt定位于开发 一种多层次的干预措施，以改善对弱势人群的儿童权利公约后续行动，这有可能减少 其他卫生系统的健康差距，并为解决其他健康状况和 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.