Increasing Colorectal Cancer Screening Rates in Community Health Centers

描述(由申请人提供)：社区卫生中心(CHC)没有适当的办公室系统，以确保为每一位符合条件的患者提供结直肠癌(CRC)筛查。社区卫生中心需要基于证据的方法来实施办公系统改革，同时考虑到它们所面临的大量资源、人员配置和时间限制。在这一需求得到满足之前，筛查率可能会保持在较低水平，这将使数千名少数族裔、低收入和未参保的患者面临不必要的风险。长期目标是提高CHC的CRC筛查率，并通过这样做来减少癌症健康差距。R21应用程序的目标是测试将办公系统工具包和外联教育结合在一起的循证执行战略的可行性。在初步数据的支持下，该项目的基本原理是，初级保健中心希望提高儿童权利委员会的筛查率，但需要以证据为基础的工具，通过培训和技术援助，这些工具可以更有效地实施和维持。虽然拟议的执行战略是循证和有希望的，但在社区卫生委员会的背景下是新颖的，在进行更大规模的评价之前，需要在这一具有挑战性的组织背景下进行可行性测试。这项研究研究将追求三个具体目标：(1)使用儿童权利公约工具包和外联专家，评估促进CRC筛查的办公系统变革的实施程度；(2)使用CRC工具包和外联专家，估计实施和维护办公系统变革的费用；(3)使用CRC工具包和外联专家，对已实施的办公系统变革进行有限的测试。为实现第一个目标，将利用创新实施概念模型所提供的访谈和调查来审查各中心实施的办公系统工具的数量和类型、提供的外联支助的数量和类型以及预测实施效果的组织因素。对于第二个目标，将使用流程图、活动日志和单价来估计实施儿童权利公约筛查程序变更的成本，并通过比较实施前后儿童权利公约筛查程序的成本和收入来计算净收益。对于第三个目标，将通过实施前和实施后的图表审计来评估用于筛查和完成筛查的有文件记录的医生建议的变化。这一项目的创新之处在于，它试图将目前在社区卫生中心进行基于系统的变革的模式从质量改进协作方法转变为在社区卫生中心资源有限的情况下承诺更大的可行性。这项拟议的研究具有重要意义，因为它有可能通过提高少数族裔、低收入和有保险人口中的CRC筛查率来改善公共卫生，并有助于了解办公室系统方法如何运作的科学知识。 公共卫生相关性：拟议的项目与公共卫生相关，因为实施办公室系统改革的有效战略使用更少的资源，实现比当前基于系统的方法更高的筛查率，可以在少数族裔、低收入和未参保的患者中预防或早期发现每年数千例结直肠癌病例。因此，拟议的研究与NCI的使命的一部分有关，该使命是进行和资助研究，以改进早期发现和诊断并减少癌症差异。

DESCRIPTION (provided by applicant): Community health centers (CHCs) do not have the office systems in place to ensure that every eligible patient is offered colorectal cancer (CRC) screening. CHCs need evidence-based approaches to implementing office- system changes that take into account the substantial resource, staffing, and time constraints they face. Until this need is met, screening rates will likely remain low, putting thousands of minority, low-income, and uninsured patients at unnecessary risk. The long-term goal is to improve CRC screening rates in CHCs and in doing so, reduce cancer health disparities. The objective of this R21 application is to test the feasibility of an evidence-informed implementation strategy that combines an office-systems toolkit and outreach education. The rationale for the project, supported by preliminary data, is that CHCs want to increase CRC screening rates, but need evidence-based tools that-with training and technical assistance-they can implement and maintain more efficiently and effectively. Although the proposed implementation strategy is evidence-informed and promising, it is novel in the CHC setting and needs to be feasibility-tested in this challenging organizational context prior to larger-scale evaluation. This research study will pursue three specific aims: (1) assess the extent of implementation of office-system changes that promote CRC screening, using the CRC toolkit and outreach specialist; (2) estimate the costs of implementing and maintaining office-system changes, using the CRC toolkit and outreach specialist; (3) conduct a limited test of the office-system changes implemented, using the CRC toolkit and outreach specialist. For the first aim, interviews and surveys informed by a conceptual model of innovation implementation will be used to examine the number and type of office-system tools that CHCs implement, the amount and type of outreach support provided, and organizational factors predictive of implementation effectiveness. For the second aim, process maps, activity logs, and unit prices will be used to estimate the cost of implementing changes to the CRC screening process and calculate net benefit by comparing the costs and revenues of CRC screening processes pre- and post-implementation. For the third aim, changes in documented physician recommendation for screening and completed screenings will be assessed through chart audits pre- and post-implementation. This project is innovative in that it attempts to shift the current paradigm for making systems-based changes in CHCs from the quality improvement collaborative approach to one that promises greater feasibility given CHCs' resource constraints. The proposed research is significant because of its potential to improve public health by increasing CRC screening rates in minority, low income and insured populations and its contribution to scientific knowledge about how the office- systems approach works. PUBLIC HEALTH RELEVANCE: The proposed project is relevant to public health because an effective strategy for implementing office-system changes that uses fewer resources and achieves higher screening rates than current systems-based approaches could lead to the prevention or early detection of thousands of colorectal cancer cases annually among minority, low-income, and uninsured patients. Thus, the proposed research is relevant to the part of the NCI's mission to conduct and fund research that improves early detection and diagnosis and reduces cancer disparities.