Developing and Testing a Digital Toolkit to Improve Colorectal Cancer Screening Rates in Federally Qualified Health Centers

项目摘要/摘要 结直肠癌(CRC)是美国癌症死亡的主要原因。国家指南建议 平均风险人群定期接受结直肠癌筛查。社区卫生中心，如具有联邦资格的 健康中心(FQHC)，为全国范围内服务不足的人群提供高质量、负担得起的医疗保健。 在FQHC接受治疗的患者中，只有44%的人在推荐的范围内完成了结直肠癌筛查 时间框架(例如，每十年一次结肠镜检查)。患者导航已被证明是改善CRC的有效方法 筛查完成率和筛查质量。患者导航的效果在以下方面是强大的 社会经济地位和种族/民族群体。此外，广泛的研究已经证明了它在FQHC中的有效性 设置。虽然有效，但患者导航需要人员和经济资源，限制了其能力 广泛传播，特别是在资源匮乏的地方，如口蹄疫保健中心。这项拟议的研究旨在完善 并测试一种名为ENAV工具包的数字健康解决方案，该解决方案旨在提高以下人群的CRC筛查接受率 在FQHC接受治疗的患者。ENAV工具包将是一个Web应用程序，将帮助做出CRC筛查决定 制作、预约提醒、准备说明/提醒、教育、激励性面试 支持，并联动后续护理。为了最大限度地扩大覆盖范围，ENAV工具包将可在任何 智能手机、平板电脑或电脑设备。对于目标1，ENAV工具包1.0将在10名参与者身上进行现场测试。 参与者将是符合结直肠癌筛查资格的FQHC患者。现场试验结果可用于精炼ENAV 内容，改善用户体验。干预的第二次迭代，ENAV工具包2.0，然后将是 在一组新的10名参与者身上进行了实地测试。第二次现场测试的结果将用于提炼和 最终确定ENAV工具包。目的2将进行一项多点随机临床试验，以评估 ENAV工具包用于改善在FQHC接受治疗的患者的结直肠癌筛查摄取率。患者(N=400)将被 随机分配到两种情况之一：ENAV工具箱组(N=200)或普通护理组(N=200)。 ENAV工具包小组的参与者将参与ENAV工具包，以协助准备和完成 CRC筛查。常规护理组的参与者将接受常规护理。主要结果(儿童权利公约 筛查完成)和二次结果(结直肠癌筛查质量、随访依从性)将被评估 在学习入学后六个月。目标3将评估变化的理论机制(例如，感知 利益、感知障碍、感知敏感度、自我效能)，以健康信念模型为指导。如果经过验证 有效，ENAV工具包将被整合到电子健康记录(EHR)中，并在 在全国范围内建立FQHC，最终目标是减轻在FQHC接受治疗的患者的结直肠癌负担。

PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) is a leading cause of cancer death in the United States. National guidelines recommend that average risk people receive regular CRC screenings. Community health centers, such as federally qualified health centers (FQHCs), provide high quality affordable healthcare to underserved populations across the nation. Among patients treated at FQHCs, only 44% have completed a CRC screening within the recommended timeframe (e.g., one colonoscopy per ten years). Patient navigation has proven effective for improving CRC screening completion rates and screening quality. The effects of patient navigation are robust across socioeconomic status and racial/ethnic group. Furthermore, extensive research has proven its efficacy in FQHC settings. Although efficacious, patient navigation requires staffing and economic resources limiting its ability to be widely disseminated, particularly in low-resourced settings like FQHCs. The proposed study aims to refine and test a digital health solution, called the eNav Toolkit, designed to improve CRC screening uptake among patients treated at FQHCs. The eNav Toolkit will be a web app that will assist with CRC screening decision making, appointment reminders, preparation instructions/reminders, education, motivational interviewing support, and linkage to follow up care. In order to maximize reach, the eNav Toolkit will be accessible on any smartphone, tablet, or computer devise. For Aim 1, the eNav Toolkit 1.0 will be field tested on 10 participants. Participants will be FQHC patients eligible for CRC screening. The field test results be applied to refine the eNav content and improve the user-experience. The second iteration of the intervention, eNav Toolkit 2.0, will then be field tested on a new set of 10 participants. The results from the second field test will be applied to refine and finalize the eNav Toolkit. Aim 2 will conduct a multi-site randomized clinical trial to evaluate the efficacy of the eNav Toolkit for improving CRC screening uptake among patients treated at FQHCs. Patients (N=400) will be randomly assigned to one of two conditions: eNav Toolkit group (N=200) or usual care group (N=200). Participants in the eNav Toolkit group will engage with the eNav Toolkit to assist in preparing for and completing the CRC screening. Participants in the usual care group will receive usual care. Primary outcomes (CRC screening completion) and secondary outcomes (CRC screening quality, follow up adherence) will be evaluated at six months after study enrollment. Aim 3 will evaluate theoretical mechanisms of change (e.g., perceived benefits, perceived barriers, perceived susceptibility, self-efficacy), guided by the health belief model. If proven efficacious, the eNav Toolkit will be integrated in the electronic health record (EHR) and disseminated across FQHCs nationwide, with the ultimate goal of decreasing the burden of CRC among patients treated at FQHCs.