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

从社区到诊所的导航，以促进服务欠缺人群的结直肠癌筛查

基本信息

批准号：
9033875
负责人：
Linda K Larkey
金额：
$ 53.83万
依托单位：
ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-06-01 至 2018-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9033875
关键词：
Adherence Adoption American Appointment Arizona Breast Cancer Control Cancer Etiology Cervical Cessation of life Clinic Code Colorectal Cancer Communities Community Healthcare Cost Effectiveness Analysis Early Diagnosis Education Educational Background Educational Intervention Effectiveness Effectiveness of Interventions Elements Evaluation Federally Qualified Health Center Foundations Funding Future Goals Health Health Personnel Health Priorities Health Services Healthcare Healthcare Systems Home environment Individual Intervention Low Income Population Low income Maintenance Malignant Neoplasms Methods Minority Modeling Morbidity - disease rate Names National Cancer Institute Outcome Participant Patients Phase Pilot Projects Policies Population Primary Health Care Protocols documentation Provider Randomized Recruitment Activity Reporting Research Site System Testing Translating Translations Underinsured Uninsured United States National Institutes of Health Visit Work aged base care systems colorectal cancer screening community setting cost cost effectiveness design dissemination research effective intervention ethnic diversity evidence base follow-up implementation research income insurance intervention effect meetings mortality novel program dissemination programs research data dissemination response screening successful intervention treatment as usual trend

项目摘要

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.

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

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Cost-Effectiveness of Community-to-Clinic Tailored Navigation for Colorectal Cancer Screening in an Underserved Population: Economic Evaluation Alongside a Group-Randomized Trial.

DOI：
10.1177/08901171211068454
发表时间：
2022-05
期刊：
AMERICAN JOURNAL OF HEALTH PROMOTION
影响因子：
2.7
作者：
Herman, Patricia M.;Bucho-Gonzalez, Julie;Menon, Usha;Szalacha, Laura A.;Larkey, Linda
通讯作者：
Larkey, Linda

Startup and implementation costs of a colorectal cancer screening tailored navigation research study.

结直肠癌筛查定制导航研究的启动和实施成本。