Systems of Support (SOS) to Increase Colon Cancer Screening and Follow-up

描述(申请人提供)：结直肠癌筛查(CRC)可降低结直肠癌(CRC)的发病率和死亡率，但仍未得到充分利用。增加结直肠癌筛查和随访的支持系统(SOS)是一项为期两年的随机对照试验，旨在增加：(1)结直肠癌筛查和(2)阳性筛查测试的随访。慢性护理模式和预防健康模式为研究设计提供了信息。对于这一竞争性修订，我们提出了两个新的辅助目标，以解决以下问题：1)医疗家庭模式是否修改(即增强或降低)SOS干预的有效性？主要目标1：比较医疗保健实施前后SOS系统水平的临床干预效果。我们假设第二年SOS系统级别的CRCs比率将继续高于UC(仅MH)，但CRCS比率将因诊所的特点及其MH组件的实施而修改(减少或增强)。为了验证这一假设，我们将收集与MH实施和临床特征相关的过程测量相关协变量的数据。7主要结果将包括MH实施和临床因素在多大程度上改变CRCs和FOBT率。2)对于那些选择年度FOBT的人，是否需要持续的系统级干预来保持CRC的增长？主要目标2：确定随时间推移的SOS系统级自动化干预的持久性和长期影响。我们假设，随着时间的推移，患者需要持续的SOS自动化干预以保持FOBT筛查的最新情况。我们还假设，与那些没有接受SOS自动化干预的人相比，以前在1-2岁完成的个人仍然更有可能完成CRC。为了检验这些假设，我们在第三年提议将仍有资格接受CRC检查(尚未接受结肠镜检查或灵活乙状结肠镜检查)的积极干预组(自动、辅助和护理管理)中的患者随机分为以下两组：A.停止自动或B.继续自动系统级FOBT干预7主要结果包括CRC和FOBT比率，明确地(是/否)在第三年，以及作为对适当CRC和FOBT覆盖范围的人员时间评估，本研究将利用现有研究队列有效地解决这些问题。 与公共健康相关：对50岁至75岁的人进行筛查可以防止结肠癌的发生和死亡，但几乎一半的人没有进行筛查。这项研究正在测试患者需要多少帮助才能完成结肠癌筛查。在这项研究的第二年，医疗计划对诊所提供医疗保健的方式进行了改变。这一变化被称为“医疗之家”，医生有更多的时间去看病人，医疗助理检查病人是否应该进行筛查测试，如结肠癌筛查，并在探视或邮寄信件时提供帮助。我们将研究“医疗院”护理是否会增加结肠癌筛查。这项研究的第二个目的是找出选择在家做大便卡片的人是否需要每年通过邮件收到这些卡片，以便及时进行筛查。

DESCRIPTION (provided by applicant): Colorectal cancer screening (CRCS) decreases colorectal cancer (CRC) morbidity and mortality, yet remains underutilized. Systems of Support to Increase Colorectal Cancer Screening and Follow-up (SOS) is a 2-year randomized controlled trial designed to increase: (1) CRC screening and (2) follow-up of positive screening tests. The Chronic Care Model and the Preventive Health Model inform study design. For this Competitive Revision we propose two new ancillary aims to address the following questions: 1) Does the medical home model modify (i.e. enhance or reduce) the effectiveness of the SOS intervention? Primary Aim #1: To compare SOS systems-level intervention effect in clinics before and after MH implementation. We hypothesize that SOS systems-level CRCS rates will continue be higher than UC (MH alone) in year 2, but CRCS rates will be modified (lessoned or enhanced) by characteristics of clinics and their implementation of MH components. To test this hypothesis we will collect data on covariates related to process measures related to implementation of the MH and clinic characteristics. 7 Primary outcomes will include to what degree CRCS and FOBT rates are modified by MH implementation and clinic factors. 2) Is a continued systems-level intervention required to maintain increases in CRCS for those choosing annual FOBT? Primary Aim #2: To determine the durability and long-term impact of SOS systems-level automated interventions over time. We hypothesize that continued SOS automated interventions are needed for patients to remain current for FOBT screening over time. We also hypothesize that individuals who have previously completed in years 1-2, will still be more likely to complete CRCS, than those not receiving SOS automated interventions. To test these hypotheses we propose in year 3 to randomize patients in the active intervention groups (auto, assist, and care managed) who are still eligible for CRCS (have not had a colonoscopy or flexible sigmoidoscopy) to either: A. Stopped Auto or B. Continued Auto systems-level FOBT interventions 7 Primary outcomes include CRCS and FOBT rates, categorically (yes/no) in year 3 and as person-time assessments of appropriate CRCS and FOBT coverage in years 1-3 This study will efficiently address these questions by taking advantage of an existing study cohort. PUBLIC HEALTH RELEVANCE: Screening people age 50 to 75 prevents colon cancer from starting and dying from it, but almost half have not been screened. This study is testing how much help patients need to get colon cancer screening done. In the second year of the study, the health plan made changes to how clinics deliver health care. This change is called the "Medical Home" and doctors are given more time to see patients and medical assistants check to see if patients are due for screening tests, such as colon cancer screening, and help at visits or mail letters. We will study whether "Medical Home" care increases colon cancer screening. A second aim of this study will to be to find out if people who choose to do stool cards at home, need to receive these in the mail every year to stay current for screening.