NY PREVENTION CARE MANAGER PROJECT

达特茅斯医学院(DMS)和临床主任网络(CDN)正在合作本附录的母项目，该项目一直在测试电话支持对从纽约市社区卫生中心接受初级保健的妇女进行乳腺癌、宫颈癌和结直肠癌筛查的影响。我们现在已经准备好进行传播(附件A--支持函)。母项目在11个社区/移民健康中心(C/MHC)进行了一项随机对照试验，招募了1400多名年龄在50-69岁之间的妇女。其中一半的妇女被分配通过预防护理管理(PCM)接受电话支持服务，而另一半则接受常规护理。通过一系列电话，训练有素、有质量监测的预防保健管理人员使用了一种手工方法，向妇女提供关于逾期筛查检查的知识，帮助妇女克服获得所需服务的障碍，并提供后续支助。我们的方法论文正在修改中。 目前的初步分析表明，PCM干预对所有三种癌症的筛查都有积极影响。例如，使用PCM后，结直肠癌筛查率几乎比基线增加了100%。 根据我们的疗效数据，我们建议将PCM干预传播到优先子组妇女--那些登记在医疗补助管理保健组织并早该进行筛查的妇女--使用一种实用的方法来加强她们的保健，这种护理将在没有研究支持的情况下在现实世界中可持续。母项目依赖于研究人员密切监督的研究人员。通过密集的研究驱动过程，确定、招募和同意患者。在本补充资料中，母公司项目团队将与医疗补助管理保健组织(MMCO)的亲和力健康计划合作，以便亲和力在创新扩散理论的指导下，为覆盖的妇女发展、提供和维持PCM干预的能力。 根据美国预防服务工作组(USPSTF)的建议，促进乳腺癌、宫颈癌和结直肠癌筛查的PCM干预措施是正在考虑的创新。PCM是对护理过程的增强，即患者获得癌症筛查的事件顺序。因为在本提案一开始就必须区分其他事件的顺序：在亲和力和MMCO范围内和其他地方实施PCM的变化过程。本补编将从三个层面研究相变管理创新的传播情况： 1.个人--亲和力涵盖被分配参加PCM干预的妇女(一个护理过程)； 2.本组织--亲和力MMCO本身，在上级项目的初步援助下，将实施和重塑PCM，使之具有可持续性(一个变革过程)； 3.以及没有参加本补编的其他区域MMCO和社区卫生中心--因为我们的母项目和传播工作的结果在这里提出，这些组织考虑实施PCM(一个变化的过程)。

Dartmouth Medical School (DMS) and Clinical Directors Network (CDN) are collaborating on the parent project to this supplement, which has been testing the impact of telephone support on the breast, cervical, and colorectal cancer screening of women who receive primary care from community health centers for the underserved in New York City. We are now ready to move forward with dissemination (Exhibit A-Letters of support). The parent project enrolled over 1,400 women age 50-69 years seen in 11 Community / Migrant Health Centers (C/MHCs) in a randomized controlled trial. Half of the women were assigned to receive telephone support services through Prevention Care Management (PCM), while the other half received usual care. Through a series of telephone calls, trained, quality-monitored Prevention Care Managers have used a manualized approach to provide knowledge to women about overdue screening tests, helped women overcome barriers to obtaining needed services, and provided follow up support. Our methods paper is in revision. Current preliminary analyses show a positive impact of the PCM intervention on screening for all three cancers. For example, colorectal cancer screening rates increased almost 100% over baseline with PCM. On the strength of our efficacy data, we propose to disseminate the PCM intervention to a priority subgroup of women-those enrolled with Medicaid managed care organizations and overdue for screening-using a practical approach to enhance their care that will be sustainable in real-world settings without research support. The parent project relied on research staff closely supervised by research investigators. Patients were identified, recruited and consented through an intensive research-driven process. In this supplement, tha parent project team will work with Affinity Health Plan, a Medicaid managed care organization (MMCO), so that Affinity develops the capacity for, provides and sustains the PCM intervention to covered women guided by Diffusion of Innovations theory. The PCM intervention, promoting screening for breast, cervical and colorectal cancer as recommended by the US Preventive Services Task Force (USPSTF), is the innovation under consideration. PCM is an enhancement to the process of care, i.e. the sequence of events by which patients obtain cancer screening. As additional sequence of events is important to distinguish at the outset of this proposal: the process of change by which PCM is implemented within the Affinity MMCO context and elsewhere. This supplement will allow study of dissemination of the PCM innovation at three levels: 1. Individuals-Affinity covered women assigned to the PCM intervention (a process of care); 2. The organization-the affinity MMCO itself, that with initial assistance from the parent project will implement and reinvent PCM to be sustainable (a process of change); 3. And other regional MMCOs and community health centers that are not participating in this supplement- as results from our parent project and dissemination work proposed here are presented and these organizations consider implementing PCM (a process of change).