Identifying Receipt of Colorectal Cancer Screening

描述(申请人提供)：结直肠癌(CRC)是美国癌症死亡的第二大原因。定期筛查CRC有助于及早发现，大大降低与CRC相关的发病率和死亡率。尽管有这些证据，但对结直肠癌筛查建议的遵守情况仍然很差。鉴于筛查结直肠癌的好处，需要制定干预措施，最终提高其利用率。这些干预措施必须针对从未接受过筛查或没有进行筛查的个人，并且必须考虑风险因素[例如，家族史、炎症性肠病、既往腺瘤病史]。应用结直肠癌筛查干预措施的一个重要障碍是准确和快速地识别需要筛查的患者的能力。在我们建议的项目中，我们将创建和评估一个创新的电子数据收集系统，以加深我们对CRC筛查的交付和使用的了解。我们将使用范德比尔特大学医疗中心附属的初级保健诊所作为测试地点，但开发的方法将足够通用，可以在任何有足够电子记录的地方工作。这个数据收集系统将建立在我们使用知识地图概念识别符(KMCI)的先前工作的基础上，KMCI最初是为了提取范德比尔特大学医学院医学院课程中代表的生物医学概念而开发的。我们将建立一个以KMCI为核心的工具，以检测CRC筛查的接收情况，并提供其背景(例如，个别风险因素、执行了哪项CRC测试、何时进行以及结果)。利用电子记录和账单(索赔)记录中的信息，该系统将能够快速和准确地识别哪些患者已经和没有接受CRC筛查测试，以及哪些患者在筛查测试后需要跟进。我们将确定KMCI用于识别CRC筛查收据的测试特征(敏感度、特异度)，并将其与自动审查账单记录进行比较。我们假设，KMCI在检测CRC筛查的接收方面将比自动审查账单记录执行得更好，并将提供关于筛查测试的更丰富的上下文信息。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Regular screening for CRC leads to early detection and a substantial reduction in CRC-related morbidity and mortality. Despite this evidence, adherence to CRC screening recommendations remains poor. Given the benefits of screening for CRC, interventions need to be developed that will ultimately increase its utilization. These interventions must be targeted towards individuals who have never been screened or are not current with their screening, and must take into account risk factors [e.g., family history, inflammatory bowel disease, history of previous adenomas]. A significant barrier to applying CRC screening interventions is the ability to accurately and quickly identify patients in need of screening. In our proposed project, we will create and evaluate an innovative electronic data collection system to enhance our understanding of the delivery and utilization of CRC screening. We will use as a test site the primary care clinics affiliated with Vanderbilt University Medical Center, but the approach developed will be general enough to work wherever adequate electronic records are available. This data collection system will build upon our prior work using the Knowledge Map Concept Identifier (KMCI), which was originally developed to extract biomedical concepts represented in the medical school curriculum at Vanderbilt University School of Medicine. We will build a tool using KMCI as its core to detect receipt of CRC screening and to provide its context (e.g., individual risk factors, which CRC test was performed, when, and the results). Utilizing information from the electronic records and billing (claims) records, this system will allow for rapid and accurate identification of which patients have and have not received CRC screening tests, and for identification of those patients that require follow-up after their screening tests. We will determine the test characteristics of KMCI (sensitivity, specificity) for identifying receipt of CRC screening, and compare this to an automated review of billing records. We hypothesize that KMCI will perform better than an automated review of billing records in detecting receipt of CRC screening, and will provide richer, contextual information regarding the screening tests.