Research Project

标题：系统级干预，以增加社区卫生中心的CRC筛查 项目摘要（Abstract）： 结直肠癌（CRC）是我们的社区合作伙伴确定为优先考虑的癌症之一。它是美国癌症死亡的第二大原因，并且在筛查，诊断阶段和生存方面存在显着差异。投保不足和未投保的成年人不太可能接受筛查，更有可能在晚期诊断出癌症，并且不太可能在CRC中存活。在这个项目中，我们将与“安全网”健康中心合作，为密苏里州的圣路易斯市和圣路易斯县以及伊利诺斯州的东圣路易斯/圣克莱尔县的医疗补助和未投保的病人提供服务。与我们的结直肠癌社区合作伙伴关系合作，我们计划进行一项随机分组延迟启动试验，以测试为社区卫生中心提供循证系统干预措施的“菜单”以提高CRC筛查率的有效性。菜单中的战略将来自循证干预措施。控制条件将是常规护理，但根据我们合作伙伴的愿望，我们将为所有参与的健康中心提供最先进的循证患者教育材料。主要结果将是CRC筛查依从性，通过对健康中心患者随机样本的自我报告调查进行测量。 我们的评估还将通过图表审计来评估筛查转诊和完成情况，对干预站点的医生和工作人员进行调查以评估实施结果，并与干预健康中心的管理部门进行离职面谈以评估干预策略的维持情况。我们制定并将遵循以社区为基础的参与性研究原则进行研究 （CBPR）。具体目标是：（1）与社区合作伙伴合作，我们将选择和完善试验的循证干预策略;（2）使用CBPR方法，我们将与合作伙伴合作实施和评估系统级干预，以提高CRC筛查率的有效性。 (3)使用RE-AIM框架，我们将与我们的合作伙伴一起评估干预健康中心对系统更改的实施和维护以及控制中心对更改的采用。与传统诊所和医疗保健提供者相比，安全网卫生中心在实施循证策略以增加筛查摄取方面面临更多挑战;但在 这一背景是新颖的。允许健康中心从一系列策略中进行选择将提供有效性的实践检验，并将增加参与健康中心的购买力和代表性。作为一项具有良好外部效度的临床试验，该项目有可能对CRC筛查率产生重大影响，并有望对CRC负担的增加产生实质性影响。这项研究是响应社会 关注CRC和无干预对照组，并通过提出CBPR随机对照试验来响应RFA，以增加CRC筛查程序的可及性和利用率。

Title: Systems-level intervenfion to increase CRC screening in community health centers Project Summary (Abstract): Colorectal cancer (CRC) is one of the cancers that our community partners have identified as a priority. It is the second leading cause of cancer death in the United States, and one with significant disparities in screening, stage of diagnosis, and survival. Underinsured and uninsured adults are less likely to be screened, more likely to have their cancer diagnosed at a late stage, and less likely to survive CRC. In this project we will work with "safety-net" health centers serving Medicaid and uninsured pafients in St. Louis City and St. Louis County in Missouri, and in East St. Louis/St. Clair County in Illinois. Working with our Colorectal Cancer Community Partnership we planned a cluster-randomized delaved start trial to test the effectiveness of offering community health centers a "Menu" of evidence-based svstems interventions for increasing rates of CRC screening. The strategies included in the Menu will be drawn from evidence-based interventions. The control condifion will be usual care, but in concordance with our partners' wishes, we will offer all participating health centers access to state-of-the-art evidence-based patient educafion materials. The primary outcome will be CRC screening adherence as measured by self-report surveys of a random sample of health center patients. Our evaluation will also be informed by a chart audit to assess screening referral and completion, surveys of physicians and staff at intervenfion sites to assess implementation outcomes, and exit interviews with administration of intervention health centers to assess maintenance of the intervention strategies. We developed and will conduct our study adhering to the principles of community-based participatorv research (CBPR). The specific aims are: (1) Working with community partners, we will select and refine the evidence based intervention strategies forthe trial; (2) Using a CBPR approach, we will collaborate with our partners to implement and evaluate the systems-level intervention for its effectiveness in increasing CRC screening rates. (3) Using the RE-AIM framework, we will work with our partners to evaluate implementation and maintenance of systems changes by intervention health centers and adoption of the changes by control centers. Compared to traditional clinics and healthcare providers, safety-net health centers face additional challenges in implementing evidence-based strategies for increase screening uptake; yet rigorously testing such strategies in this context is novel. Allowing health centers to select from a menu of strategies will provide a pracfical test of effectiveness, and will increase buy-in and representativeness of participafing health centers. As a pracfical clinical trial with good external validity, this project has the potential for significant impact on CRC screening rates with promise for substantial impact on disparifies in CRC burden. This study is responsive to community concerns about CRC and about no-intervention control groups, and is responsive to the RFA by proposing a CBPR randomized controlled trial to increase access to and utilizafion of CRC screening procedures.