Strategies and Opportunities to Stop Colon Cancer in Priority Populations

描述：联邦政府制定了“健康人2020”的目标，即结肠直肠癌（CRC）筛查率达到70.5%，但几乎一半符合条件的美国成年人没有及时进行筛查。在少数民族和低收入人群中，结直肠癌筛查率极低。为了解决这一差异，我们将开发和测试一个基于文化的、基于医疗保健系统的项目，以提高OCHIN的结直肠癌筛查率。OCHIN是一个由200多家联邦合格医疗中心（fqhc）组成的社区协作网络。种族和少数民族以及低收入和医疗服务不足的人群越来越多地在fqhc接受初级保健，这些中心每年为全美近1900万患者提供服务。OCHIN是全国最大的FQHC网络。它的综合电子健康记录系统结合了医疗、实验室和索赔数据，将为我们的研究提供一个新颖而强大的数据源。在第一阶段（01年），我们将在两个OCHIN fqhc试点以循证方法提高CRC筛查的参与。这一阶段将包括评估干预措施的可行性、有效性和成本。在第二阶段（2005年），我们将进行一项比较有效性的实用临床试验，使用混合方法来评估我们为FQHC诊所设计的CRC筛查项目的采用、实施和维护。在整个项目中，我们将与OCHIN临床医生和患者、社区代表、州决策者和研究人员组成的多元化规划咨询小组合作，采用基于社区的参与式研究原则。由于OCHIN是最大的单一FQHC网络，并为不同种族，民族和保险状况的患者提供服务，因此我们的结果将在加速服务不足人群的CRC筛查研究方面发挥变革性作用。我们的计划将扩大电子健康信息的有效使用；协同实现提高癌症筛查率、解决健康差距和降低卫生保健费用的国家目标；并作为未来基于系统的方法的催化剂，以改善fqhc和其他卫生系统的保健服务。

DESCRIPTION: The federal government has set a Healthy People 2020 goal of a 70.5% screening rate for colorectal cancer (CRC), but almost half of eligible U.S. adults are not up to date on their screenings. Among minority and low-income populations, the CRC screening rate is extremely low. To address this disparity, we will develop and test a culturally tailored, health care system-based program to improve CRC screening rates in OCHIN, a community-based collaborative network of more than 200 Federally Qualified Health Centers (FQHCs). Racial and ethnic minorities, along with low-income and medically underserved populations, increasingly receive their primary care at FQHCs, which serve nearly 19 million patients annually throughout the United States. OCHIN is the largest national FQHC network. Its integrated electronic health record system combining medical, laboratory, and claims data will serve as a novel and robust data source for our study. In Phase I (Year 01), we will pilot-test an evidence-based approach to improving participation in CRC screening in two OCHIN FQHCs. This phase will include an assessment of the intervention s feasibility, effectiveness, and cost. In Phase II (Years 02 05), we will conduct a comparative effectiveness pragmatic clinical trial, using a mixed-methods approach to evaluate the adoption, implementation, and maintenance of our CRC screening program designed explicitly for FQHC clinics. Throughout the project, we will work with a diverse planning advisory group of OCHIN clinicians and patients, community representatives, state policy makers, and researchers, using principles of Community-Based Participatory Research. Because OCHIN is the largest single FQHC network and serves patients who are diverse in race, ethnicity, and insurance status, our results will play a transformative role in accelerating CRC screening research in underserved populations. Our program will expand meaningful use of electronic health information; synergistically meet national goals to improve cancer screening rates, address health disparities, and reduce health care costs; and act as a catalyst for future systems-based approaches to improve care delivery in FQHCs and other health systems.