Navigation from Community to Clinic to promote CRC Screening in Underserved Popul

描述（由申请人提供）：定期筛查有助于结直肠癌（CRC）的早期诊断，并有助于降低这种癌症导致的发病率和死亡率。尽管最近的一份报告显示，CRC筛查试验的使用率呈上升趋势，但少数民族和低收入人群的筛查率仍然不理想。接受CRC筛查的转诊是依从性最强的预测因素之一，但在那些没有诊所或很少去初级保健提供者的人中，转诊是不太可能的，这些因素在穷人和少数民族人群中更常见。我们目前提出的项目旨在建立在我们的团队和其他人建立的证据的基础上，以测试一种在特别难以接触的人群中传播循证CRC筛查宣传和协议的方法，其中许多人没有指定“常规”初级保健诊所或提供者。这项两阶段研究的目的是测试使用“社区到诊所导航员”干预措施的有效性，引导来自特别难以接触、多元文化和保险不足人群的个人进入初级保健诊所，接受医疗保健服务提供者转诊进行CRC筛查（第一阶段），随后，对于那些去诊所的人，检查第一阶段干预对完成CRC筛查（第二阶段）的影响。成本效益分析将为进一步评价 干预的传播政策潜力。目标1：测试社区团体教育+定制导航与社区团体教育的有效性，仅在50岁或以上的低收入，多文化亚利桑那州居民中增加诊所就诊率。对于那些预约诊所的人来说，作为一个单独的关键步骤，我们将使用I期组分配作为分析中的控制变量，检查随访至筛选的效果。预约诊所的患者将获得基于诊所的导航，这已经成为我们几个研究诊所的常规护理。目标2：跟踪第一阶段干预分配对提高就诊者CRC检测完成率的影响。目标3和4旨在为将调查结果应用于更广泛的背景做好准备。目标3：确定干预措施的每个阶段的成本效益，以增加50至75岁的低收入，多元文化的亚利桑那州居民的CRC筛查完成率。探索性目标4：使用RE-AIM模型检查从社区到诊所到最终筛查的计划传播水平，询问“社区到诊所导航的覆盖范围、有效性、采用、实施和维护程度以及诊所到筛查结果如何？“要测试的中心功能，使用定制的信息从社区导航到诊所，是一种新的干预措施，在最初的试点研究中显示具有相当大的影响。已证明，引导患者进行筛查的现行方案可有效实现筛查依从性并降低死亡率。对于拟议研究的两个步骤，我们已经调整了现实社区/诊所环境的设计，以最大限度地提高翻译潜力和最有效实践的成本估计。

DESCRIPTION (provided by applicant): Regular screening facilitates the early diagnosis of colorectal cancer (CRC) and contributes to the reduction of morbidity and mortality this cancer causes. Although a recent report showed an increasing trend in utilization of CRC screening tests, screening rates for minorities and low-income populations remain suboptimal. Having received a referral for CRC screening is one of the strongest predictors of adherence, but referrals are unlikely among those who have no clinic home, or rarely visit a primary care provider, factors that are more common among the poor and minority populations. Our currently proposed project is designed to build upon the evidence established by our team and others to test a method of disseminating evidence-based CRC screening promotion and protocols among a particularly difficult-to-reach population, many of whom do not name a "regular" primary care clinic or provider. The purpose of this two-phase study is to test the effectiveness of an intervention using "community-to-clinic navigators" to guide individuals from an especially hard-to-reach, multicultural and underinsured population into primary care clinics to receive a healthcare provider referral for CRC screening (Phase I) and, subsequently, for those who attend the clinic, to examine the impact of this phase I intervention on completion of CRC screening (Phase II). Cost-effectiveness analysis will lay the foundation for further evaluation of the dissemination policy potential of the intervention. Aim 1: Test effectiveness of community group education + tailored navigation versus community group education only in increasing clinic attendance among low-income, multi-cultural Arizona residents aged 50 or older. As a separate critical step for those who make clinic appointments, we will examine the effect of follow through to screening, using Phase I group assignment as a control variable in analysis. Patients making clinic appointments will receive the clinic-based navigation that has become usual care in several of our study clinics. Aim 2: Track effects of Phase I intervention assignment on increasing CRC test completion among those who attend clinic. Aims 3 and 4 are designed to prepare to translate findings to broader contexts. Aim 3: Determine the cost-effectiveness of each phase of the interventions on increasing CRC screening completion among low-income, multicultural Arizona residents aged 50 to 75 years. Exploratory Aim 4: Examine the levels of program dissemination from community to clinic to final screenings using the RE-AIM model, asking, "What is the degree of Reach, Efficacy, Adoption, Implementation, and Maintenance of the community-to-clinic navigation, and clinic-to-screening outcomes?" The central feature to be tested, navigation from community to clinic using tailored messages, is a novel intervention, shown in an initial pilot study to have a sizeable effect. The protocols in plae to navigate patients to screening have been shown to be effective for achieving screening adherence and reducing mortality. For both steps of the proposed research, we have adapted the design for realistic community/clinic contexts for maximum translation potential and cost estimates for most effective practices.