Increasing Colorectal Cancer Screening Rates in Community Health Centers

描述（由申请人提供）：社区卫生中心（CHC）没有办公系统，以确保每个符合条件的患者都能接受结直肠癌（CRC）筛查。社区卫生中心需要采取基于证据的方法来实施办公系统变革，并考虑到它们面临的大量资源、人员配备和时间限制。在这一需求得到满足之前，筛查率可能会保持在较低水平，使成千上万的少数民族、低收入和没有保险的患者面临不必要的风险。长期目标是提高社区卫生中心的CRC筛查率，从而减少癌症健康差距。这一R21应用程序的目的是测试将办公系统工具包和外联教育相结合的循证执行战略的可行性。该项目的基本原理得到了初步数据的支持，即CHCs希望提高CRC筛查率，但需要基于证据的工具，通过培训和技术援助，他们可以更有效地实施和维护。虽然拟议的执行战略是有证据的，有希望的，但它在社区卫生中心的环境中是新的，需要在大规模评价之前在这一具有挑战性的组织环境中进行可行性测试。这项研究将追求三个具体目标：（1）利用《儿童权利公约》工具包和外联专家，评估促进《儿童权利公约》筛查的办公室系统变革的实施程度;（2）利用《儿童权利公约》工具包和外联专家，估计实施和维持办公室系统变革的成本;（3）利用《儿童权利公约》工具包和外联专家，对实施的办公室系统变革进行有限测试。对于第一个目标，将使用基于创新实施概念模型的访谈和调查，以检查社区卫生中心实施的办公室系统工具的数量和类型，提供的外联支持的数量和类型，以及预测实施效果的组织因素。对于第二个目标，将使用流程图、活动日志和单价来估计实施CRC筛选流程变更的成本，并通过比较实施前后CRC筛选流程的成本和收入来计算净效益。对于第三个目标，将通过实施前和实施后的图表审核评估记录的医生筛选建议和已完成筛选的变更。这个项目是创新的，因为它试图改变目前的模式，使社区卫生中心的系统为基础的变化，从质量改进协作的方法，以一个承诺更大的可行性，鉴于社区卫生中心的资源限制。这项拟议的研究意义重大，因为它有可能通过提高少数民族、低收入和有保险人群的CRC筛查率来改善公共卫生，并有助于了解办公室系统方法如何工作的科学知识。

DESCRIPTION (provided by applicant): Community health centers (CHCs) do not have the office systems in place to ensure that every eligible patient is offered colorectal cancer (CRC) screening. CHCs need evidence-based approaches to implementing office- system changes that take into account the substantial resource, staffing, and time constraints they face. Until this need is met, screening rates will likely remain low, putting thousands of minority, low-income, and uninsured patients at unnecessary risk. The long-term goal is to improve CRC screening rates in CHCs and in doing so, reduce cancer health disparities. The objective of this R21 application is to test the feasibility of an evidence-informed implementation strategy that combines an office-systems toolkit and outreach education. The rationale for the project, supported by preliminary data, is that CHCs want to increase CRC screening rates, but need evidence-based tools that-with training and technical assistance-they can implement and maintain more efficiently and effectively. Although the proposed implementation strategy is evidence-informed and promising, it is novel in the CHC setting and needs to be feasibility-tested in this challenging organizational context prior to larger-scale evaluation. This research study will pursue three specific aims: (1) assess the extent of implementation of office-system changes that promote CRC screening, using the CRC toolkit and outreach specialist; (2) estimate the costs of implementing and maintaining office-system changes, using the CRC toolkit and outreach specialist; (3) conduct a limited test of the office-system changes implemented, using the CRC toolkit and outreach specialist. For the first aim, interviews and surveys informed by a conceptual model of innovation implementation will be used to examine the number and type of office-system tools that CHCs implement, the amount and type of outreach support provided, and organizational factors predictive of implementation effectiveness. For the second aim, process maps, activity logs, and unit prices will be used to estimate the cost of implementing changes to the CRC screening process and calculate net benefit by comparing the costs and revenues of CRC screening processes pre- and post-implementation. For the third aim, changes in documented physician recommendation for screening and completed screenings will be assessed through chart audits pre- and post-implementation. This project is innovative in that it attempts to shift the current paradigm for making systems-based changes in CHCs from the quality improvement collaborative approach to one that promises greater feasibility given CHCs' resource constraints. The proposed research is significant because of its potential to improve public health by increasing CRC screening rates in minority, low income and insured populations and its contribution to scientific knowledge about how the office- systems approach works.