Colorectal Cancer Screening in County Health Centers

描述（由申请人提供） 拟议研究的目的是评估和加强县卫生中心初级保健实践中结直肠癌（CRC）筛查的提供，利用和相关结果。该项目是纽约州立大学斯托尼布鲁克分校预防医学系和萨福克县卫生服务部之间的合作努力。具体目的是测试一种创新的方法，以促进CRC筛查交付和利用的做法，服务于多民族，贫困人口，通过互动的继续医学教育（CME）提供者的干预。 CME干预旨在改善提供者的筛查方法、CRC风险沟通、行为咨询以及使用系统方法提供临床预防服务。配对的县卫生中心将被随机分为干预或对照组，以测试CME干预措施。建议的变更和筛选的完成将通过对干预前后健康中心患者记录的稽查进行评估。干预前后调查将用于跟踪提供者知识、态度和自我报告做法的变化。将进一步开发县计算机化病历/管理系统，以监测CRC筛查的完成情况，包括跟踪转诊到已建立转诊联系的专科提供者的程序。 CRC风险评估和沟通及其在改善这一人群中的患者决策中的作用将通过试点评估进行探讨。将对与卫生中心提供者有联系的随机选择的患者子集进行干预前后的电话调查。这将检查医生-患者访视互动，并评估风险认知，风险咨询，以及关于CRC测试选项和自我报告的筛选方法和不良事件的可接受性的共同决策。 这项研究将证明在何种程度上实施有组织的方法，以CRC筛查交付影响筛查利用初级保健的做法，服务于多民族，贫困人口。该研究的重点是关于影响供应商采用CRC指南的因素的重要问题，以及对此类患者进行CRC筛查的建议，以及患者遵守的决定。

DESCRIPTION (provided by applicant) The objective of the proposed research is to assess and enhance colorectal cancer (CRC) screening delivery, utilization, and related outcomes within county health center primary care practices. The project is a collaborative effort between the Department of Preventive Medicine, SUNY at Stony Brook, and the Suffolk County Department of Health Services. The specific aim is to test an innovative approach to promoting CRC screening delivery and utilization within practices serving multiethnic, underprivileged populations, through an interacting continuing medical education (CME) provider intervention. The CME intervention is designed to improve providers' screening methods, CRC risk communication, behavioral counseling, and use of a systems approach to the delivery of clinical preventive services. Matched pairs of county health centers will be randomized into intervention or control practices for testing the CME intervention. Changes in recommendations and completion of screening will be evaluated using an audit of pre-post- intervention health center patient records. Pre-post- intervention surveys will be used to follow changes in provider knowledge, attitudes, and self-reported practices. The county computerized patient record/management system will be further developed for monitoring completion of CRC screening, including tracking procedures referred to specialty providers with established referral linkages. CRC risk assessment and communication and its role in improving patient decision-making among this population will be explored through a pilot evaluation. A pre-post- intervention telephone survey of a subset of randomly selected patients linked to health center providers will be conducted. This will examine the doctor-patient visit interaction and evaluate risk perception, risk counseling, and shared decision-making with respect to CRC test options and self-reported acceptability of screening methods and adverse events. The research will demonstrate the extent to which the implementation of organized approaches to CRC screening delivery influences screening utilization in primary care practices that serve multiethnic, underprivileged populations. The research focuses on important questions regarding factors influencing provider adoption of CRC guidelines and recommendations for CRC screening of such patients, as well as patient decisions to comply.