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引起的发病率和死亡率。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，但转诊不太可能发生在那些没有诊所或很少访问初级保健提供者的人群中，这些因素在穷人和少数民族人群中更为常见。我们目前提出的项目旨在以我们的团队和其他人建立的证据为基础，在特别难以到达的人群中测试一种传播基于证据的CRC筛查推广和协议的方法，其中许多人没有“常规”初级保健诊所或提供者的名字。这项两阶段研究的目的是测试使用“社区到诊所导航员”的干预措施的有效性，以指导来自特别难以到达的、多元文化和保险不足的人群的个人进入初级保健诊所接受医疗保健提供者推荐的CRC筛查（第一阶段），随后，对于那些参加诊所的人，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奠定基础

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.