Increasing CRC Screening in Health Plan Members

描述（由申请人提供）：结直肠癌是美国癌症死亡的第二大常见原因。早期发现和干预可以显著降低结直肠癌（CRC）的发病率和死亡率，目前的指南建议50岁以上无症状的成年人定期通过几种方式（FOBT、乙状结肠镜检查、结肠镜检查或双重对比钡灌肠）中的一种进行筛查。然而，CRC筛查在美国仍未得到充分利用，超过一半的成年人没有遵守这些建议。由于CRC筛查使用的关键预测因素包括医生建议和是否有健康保险，并且考虑到增加筛查使用的循证策略的可用性，因此在健康计划成员人群中进行有效性研究非常重要。我们的研究小组建议与一家主要的健康保险公司进行参与性研究，以测试基于社区的行为干预措施的可转移性，从而增加结直肠癌筛查的提供。

DESCRIPTION (provided by applicant): Colorectal cancer is the second most common cause of cancer death in the United States. Early detection and intervention can significantly reduce morbidity and mortality from colorectal cancer (CRC), and current guidelines recommend that asymptomatic adults overage 50 periodically obtain screening by one of several modalities (FOBT, sigmoidoscopy,colonoscopy,or double contrast barium enema). However, CRC screening remains substantially underutilized in the U.S., and more than half of all adults do not adhere to these recommendations. Because key predictors of CRC screening utilization include a physician recommendation and having health insurance, and given the availability of evidence-based strategies for increasing screening uptake, it is important to conduct effectiveness studies in health plan member populations. Our research team proposes to conduct participatory research with a major health insurer, in order to test the transferability of community based behavioral interventions that can increase provision of colorectal cancer screening. We will conduct a cluster-randomized trial in health practices in Georgia and North Carolina, to test the effectiveness of a videotape-based decision aid and academic detailing for increasing adherence to CRC screening guidelines. 30 large group practices will be recruited and randomized to receive usual care (routine reminders) or a combined videotape decision aid and academic detailing intervention. In each practice, 30 patients between the ages of 52 and 75, without current CRC screening history, will be enrolled into the study. The intervention will continue for up to 2 years for still-unscreened participants. The main outcome will be provision (or receipt) of an evidence-based modality of CRC screening according to the US Preventive Services Task Force Guidelines (FOBT, flexible sigmoidoscopy, colonoscopy, or double contrast barium enema). The research team has already begun a participatory research process with key leaders in Quality Improvement and the Medical Economics Units at Aetna, one of the nation's largest health insurers. Unique features of the proposed study include its potential to establish systems to increase screening uptake that will help fulfill HEDIS requirements; improving our understanding of how screening promotion interventions work in both White and Black populations; and forging collaborative relationships between public health and health care researchers, and the affected communities of health plans and health care providers.