Research Project

项目摘要(摘要)： 结直肠癌(CRC)是我们的社区合作伙伴已确定为优先事项的癌症之一。它是美国癌症死亡的第二大原因，在筛查、诊断阶段和生存率方面存在显著差异。未参保和未参保的成年人接受筛查的可能性较小，他们的癌症更有可能在晚期被诊断出来，而且不太可能在CRC中存活。在这个项目中，我们将与为密苏里州圣路易斯市和圣路易斯县以及伊利诺伊州东圣路易斯/圣克莱尔县的医疗补助和未参保患者提供服务的“安全网”健康中心合作。与我们的结直肠癌社区伙伴关系合作，我们计划了一项整群随机的Delaved Start试验，以测试为社区卫生中心提供一系列循证系统干预措施以提高结直肠癌筛查率的有效性。菜单中包括的战略将从循证干预中提取。控制条件将是常规护理，但为了与我们合作伙伴的意愿一致，我们将为所有参与的卫生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，这是通过对健康中心患者的随机样本进行自我报告调查来衡量的。 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，对干预地点的医生和工作人员进行调查以评估实施结果，以及与干预健康中心的管理部门进行离职访谈以评估干预策略的维护。我们制定并将遵循以社区为基础的参与性研究的原则进行我们的研究 (CBPR)。具体目标是：(1)我们将与社区合作伙伴合作，选择和完善试验的循证干预策略；(2)采用CBPR方法，我们将与我们的合作伙伴合作，实施和评估系统层面的干预措施，以提高结直肠癌筛查率。 (3)使用RE-AIM框架，我们将与我们的合作伙伴合作，评估干预卫生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，安全网健康中心在实施基于证据的策略以增加筛查接受率方面面临着额外的挑战；但在 这一背景是新颖的。允许卫生中心从一系列战略中进行选择将提供对有效性的实际测试，并将增加参与的卫生中心的认可度和代表性。作为一项具有良好外部有效性的实际临床试验，该项目有可能对结直肠癌筛查率产生重大影响，并有望对结直肠癌负担的差异产生实质性影响。这项研究是对社区的响应 委员会对儿童权利委员会和非干预控制组表示关切，并对RFA作出回应，提出了一项CBPR随机对照试验，以增加儿童对儿童权利委员会筛查程序的获取和利用。

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 patients 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 condition 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 education 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 intervention 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 participatory research (CBPR). The specific aims are: (1) Working with community partners, we will select and refine the evidence based intervention strategies for the 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 practical test of effectiveness, and will increase buy-in and representativeness of participating health centers. As a practical clinical trial with good external validity, this project has the potential for significant impact on CRC screening rates with promise for substantial impact on disparities 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 utilization of CRC screening procedures.