Primary Care Colorectal Ca Screening Surveillance System

结直肠癌是美国一个重要的公共卫生问题。尽管研究表明筛查可以降低这种癌症的发病率和死亡率，但流行病学数据显示，结直肠癌病例和死亡人数一直很高。此外，很高比例的病例是在晚期被诊断出来的，而此时的治疗效果要差得多。这些发现表明，结直肠癌筛查的提供和利用存在问题。筛查工作以初级保健环境为基础，我们建议实施电子初级保健结直肠癌筛查监测系统，涉及新墨西哥州退伍军人管理局(VA)医疗保健系统、新墨西哥大学医学院和洛夫莱斯·桑迪亚卫生系统。这些组织是新墨西哥州三个主要的医疗保健提供者，为不同地理和种族的人群提供服务。 我们将使用这个信息系统，通过描述新墨西哥州初级保健实践中结直肠癌筛查的交付、利用、效率和结果，来解决PAR-02-042，初级保健实践中的结直肠癌目标。我们将从电子临床和账单档案和电子医疗记录中收集结直肠癌筛查和结果数据，包括三个医疗系统的初级保健诊所及其相关的胃肠病学诊所和病理实验室。将收集以下方面的具体数据：患者(人口、临床病史)和医疗保健系统(地理位置、诊所类型、提供者类型、筛查计划)特征；结直肠癌筛查测试的提供，包括粪便潜血测试、内窥镜检查和放射学程序；患者对这些筛查服务的利用；从订购/提供筛查和诊断测试到测试完成/治疗开始的时间间隔；筛查和诊断测试的结果，包括病理结果和初步癌症治疗；以及各种结直肠癌筛查测试的诊断表现特征。这些临床数据将被链接到新墨西哥州肿瘤登记处，这是一个全州范围的监测流行病学和最终结果(SEER)登记处，以识别流行和发生的结直肠癌病例，使我们能够评估筛查率和癌症结果。将进行适当的统计测试以实现研究目标，包括对受试者的描述、筛查检测率、目前筛查的患者比例、完成筛查/诊断检测和开始治疗的中位数时间，以及与这些结果相关的患者和保健系统因素。我们还将评估结直肠癌筛查试验的诊断性能，包括阳性预测价值和成分率。 除了解决PAR的目标外，建立初级保健结直肠癌筛查监测系统还将使我们能够跟踪未来筛查干预措施在初级保健实践中的传播情况，并评估旨在提高结直肠癌筛查速度和效率的卫生保健系统改革的效果。

DESCRIPTION (provided by applicant) Colorectal cancer is an important public health problem in the United States. Despite studies showing that screening can reduce the incidence and mortality of this cancer, epidemiologic data show consistently high numbers of colorectal cancer cases and deaths. Furthermore, a high proportion of cases are being diagnosed at an advanced stage, when treatment is far less effective. These findings suggest that there are problems in the delivery and utilization of colorectal cancer screening. Screening efforts are based in primary care settings and we propose to implement an electronic primary care colorectal cancer screening surveillance system involving the New Mexico Veterans Administration (VA) Health Care System, the University of New Mexico School of Medicine, and the Lovelace Sandia Health System. These organizations are three of the major health care providers in the state of New Mexico, and serve very geographically and ethnically diverse populations. We will use this information system to address objectives of PAR-02-042, Colorectal Cancer in Primary Care Practice, by describing colorectal cancer screening delivery, utilization, efficiency, and outcomes in primary care practices in New Mexico. We will collect colorectal cancer screening and outcome data from electronic clinical and billing files and electronic medical records encompassing the primary care clinics in the three health systems and their associated gastroenterology clinics and pathology labs. Specific data will be collected on patient (demographic, clinical history) and health care system (geographic site, clinic type, provider type, screening programs) characteristics; delivery of colorectal cancer screening tests, including fecal occult blood testing, endoscopic procedures, and radiolologic procedures; patient utilization of these screening services; time intervals from ordering/providing screening and diagnostic tests to test completion/treatment initiation; results of screening and diagnostic testing, including pathologic findings and initial cancer treatment; and the diagnostic performance characteristics of the various colorectal cancer screening tests. These clinical data will be linked to the New Mexico Tumor Registry, a statewide Surveillance Epidemiology and End Results (SEER) registry, to identify prevalent and incident colorectal cancer cases, enabling us to assess screening rates and cancer outcomes. Appropriate statistical tests will be performed to address the study aims, including descriptions of subjects, screening testing rates, proportion of patients currently screened, median time to completion of screening/diagnostic testing and initiating treatment, and the patient and health care system factors associated with these outcomes. We will also evaluate the diagnostic performance of colorectal cancer screening tests, including positive predictive value and yield. In addition to addressing the objectives of the PAR, establishing a primary care colorectal cancer screening surveillance system will also enable us to track the diffusion of future screening interventions into primary care practice and evaluate the effects of health care system changes designed to increase the rate and efficiency of colorectal cancer screening.