Implementing evidence based colorectal cancer screening in rural clinics

在农村诊所实施循证结直肠癌筛查

• 批准号: 10567653
• 负责人: Victoria Lee Champion
• 金额: $ 66.35万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10567653
• 关键词: Adoption; Affect; Cancer Etiology; Cancer Intervention; Cessation of life; Clinic; Clinical; Colonoscopy; Colorectal Cancer; Data; Diagnostic; Dose; Effectiveness; Evidence based intervention; Goals; Guidelines; Health Services; Immunologic Tests; Incidence; Indiana; Individual; Intervention; Interview; Knowledge; Maintenance; Measures; Modeling; Outcome; Patients; Persons; Physicians; Policies; Preparation; Promoting Action on Research Implementation in Health Services framework; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recommendation; Resolution; Risk; Rural; Rural Health; Specialist; Test Result; Testing; Variant; budget impact; colorectal cancer screening; contextual factors; cost; cost effective; cost estimate; cost outcomes; cost-effectiveness evaluation; educational atmosphere; effectiveness evaluation; effectiveness outcome; evidence base; experience; falls; future implementation; implementation evaluation; implementation facilitation; implementation outcomes; implementation process; implementation strategy; improved; innovation; mortality; patient navigation; primary care practice; response; rural area; rural health clinic; rural setting; screening; treatment as usual; uptake

Project Summary/Abstract Colorectal cancer (CRC) remains the third most common cause of cancer mortality in the US with 53,200 deaths expected in 2021, even though this number could be greatly reduced through appropriate screening.1 Compared to their urban counterparts, individuals living in rural areas experience a 50% higher incidence of CRC (OR 1.50, CI:1.43-1.57) and 35% higher mortality (OR 1.35,CI: 1.26-1.45), with rural segments of the US falling far below the National Colorectal Cancer Roundtable CRC screening goal of 80%.2-4-5 Equally poor results are found for the resolution of a positive fecal immunological test (FIT) result, which occurs in 8% of all patients initially tested with FIT. Only 50 to 55% of individuals with positive FIT results follow through with a diagnostic colonoscopy.7-11 One of the most effective approaches to increasing CRC screening is an evidence-based intervention (EBI) combining a mailed (FIT) and patient navigation (PN).12 Unfortunately, implementation of this EBI in rural settings is limited. Thus, in response to the call to identify strategies for overcoming barriers to the adoption of evidence-based interventions (PAR-19-274), we will evaluate the effectiveness of bundled facilitation implementation strategies to increase uptake of EBI’s for CRC screening. Our aims support the modeling necessary to guide future implementation of the EBI for CRC screening in rural clinics. In Aim 1, we will evaluate the ability of an implementation of an EBI to improve CRC screening and diagnostic colonoscopy rates, defined as completed screening episode (effectiveness) through implementation of an EBI for CRC screening in rural Indiana. We hypothesize that a complete screening episode of CRC screening (FIT or screening colonoscopy), including diagnostic colonoscopy uptake following positive FIT, will be higher following implementation of an EBI and throughout maintenance compared to baseline (usual care). Resolution with diagnostic colonoscopy and repeat screening with FIT will be handled as exploratory outcomes. In Aim 2 we will evaluate the variation in contextual factors (innovation, recipient, inner and outer context), implementation strategies and implementation outcomes (reach and implementation) using mixed data (qualitative interviews and quantitative measures) to build implementation profiles of nine rural clinics. In Aim 3, we estimate the cost and budget impact of the deployment of implementation strategies and processes for rural clinics and evaluate the cost-effectiveness of implementing and sustaining the CRC screening intervention.

项目总结/摘要 结直肠癌（CRC）仍然是美国癌症死亡的第三大常见原因， 预计2021年的死亡人数，即使这一数字可以通过适当的筛查大大减少。 与城市居民相比，生活在农村地区的人的发病率高出50%。 CRC（OR 1.50，CI：1.43-1.57）和35%的死亡率（OR 1.35，CI：1.26-1.45），美国农村地区 远远低于国家结直肠癌圆桌会议CRC筛查目标80%。2 -4-5 结果被发现为阳性粪便免疫学试验（FIT）结果的分辨率，这发生在8%的所有 最初接受FIT测试的患者。只有50%至55%的个人与积极的FIT结果遵循通过与 诊断性结肠镜检查。7 -11 增加CRC筛查的最有效方法之一是循证干预（EBI） 结合邮寄（FIT）和患者导航（PN）。12不幸的是，在农村实施EBI 设置有限。因此，为了响应关于确定克服障碍的战略的呼吁， 循证干预（PAR-19-274），我们将评估捆绑促进的有效性 实施战略，以增加采用EBI的CRC筛查。我们的目标是支持 因此，有必要指导未来在农村诊所实施EBI进行CRC筛查。 在目标1中，我们将评估实施EBI改善CRC筛查和诊断的能力。 结肠镜检查率，定义为通过实施EBI完成的筛查事件（有效性） 用于印第安纳州农村的CRC筛查。我们假设一个完整的筛查集CRC筛查（FIT 或筛查性结肠镜检查），包括FIT阳性后的诊断性结肠镜检查摄取， 与基线（常规护理）相比，在实施EBI后和整个维持期间。 诊断性结肠镜检查和FIT重复筛查的消退将作为探索性处理 结果。在目标2中，我们将评估情境因素（创新、接受者、内部和外部）的变化 背景）、实施战略和实施成果（范围和实施）， 数据（定性访谈和定量措施），以建立九个农村诊所的实施概况。 在目标3中，我们估计部署实施战略的成本和预算影响， 农村诊所的流程，并评估实施和维持CRC的成本效益 筛查干预。