Patient-Centered Reminders to Inform, Motivate, and Engage Colorectal Cancer Screening Adherence in Rural Communities: The PRIME-CRC Trial

项目摘要/摘要：我们将扩大现有的，以病人为中心的健康素养战略，以促进 在资源有限的农村卫生诊所，通过以下方式长期坚持结直肠癌（CRC）筛查： 结肠镜检查或每年粪便免疫化学试验（FIT）。根据最近完成的试验，我们将利用 消费者技术，现在在农村地区，并实施多方面的方法- 专为资源有限的联邦合格医疗中心（FQHC）的规模而设计。虽然取得了重大进展， 尽管已经作出了改进CRC筛查的努力，但对这些指导方针的遵守情况并不理想，差异仍然存在。 特别是，在资源有限的农村社区卫生服务中心接受护理的成年人很难开始和 通过最常用的方法FIT保持每年CRC筛查。在过去的十年里，我们的团队 研究了特定干预措施的有效性，以提高初始和重复CRC筛查的完成率 在低收入、低卫生知识、种族/民族多样化的农村地区，大多数 的患者将完成初始测试（67% - 69%），但很少（32% - 40%）在第2年完成年度测试 和3.这表明需要一种“阶梯式护理”的方法来促进长期的CRC筛查。我国农村 由于州医疗补助计划的限制，到目前为止，健康素养干预仅限于FIT 向农村卫生和保健中心提供结肠镜检查服务的覆盖率和临床带宽。医疗补助的变化 扩大了结肠镜检查的应用范围。我们现在提出一种新的干预措施， 从我们以前的研究和最近的文献中了解到-以患者为中心的提醒， 在我们提出的2组随机对照试验（N=1200）中， PRIME-CRC和增强型常规护理组将接受我们的健康素养循证实践， 提供CRC患者信息和咨询，以帮助患者做出选择FIT或 结肠镜检查和简化的测试说明。PRIME-CRC还将采用阶梯式护理方法， 提醒患者为计划的结肠镜检查做好适当的CRC筛查准备，或完成年度 匹配附件. PRIME-CRC组的患者将通过自动呼叫或 来自其医疗保健提供者的SMS文本（基于患者偏好）（录音或个性化文本） 主要结果将是完成结肠镜检查或3年内的年度FIT。我们的具体目标 测试PRIME-CRC干预措施在提高CRC筛查完成率方面的有效性， 农村社区卫生服务与加强常规护理相比。调查干预是否可以减少CRC 通过患者健康素养、种族或性别筛选差异。确定PRIME-CRC的保真度或可靠性 组件，并探讨患者，提供者和医疗保健系统的实施障碍。评价 从人力资源管理局的角度来看，与干预有关的成本。这项研究扩展了我们团队长期以来 在卫生知识普及、卫生差距、农村卫生和癌症筛查方面开展协作。

Project Summary/Abstract: We will expand an existing, patient-centered, health literacy strategy to promote longer-term adherence to colorectal cancer (CRC) screening in resource-limited, rural health clinics via colonoscopy or annual fecal immunochemical test (FIT). Guided by recently completed trials, we will leverage consumer technologies that are now available in rural areas and implement a multifaceted approach - designed for scale in resource-limited federally qualified health centers (FQHCs). While significant gains have been made to improve CRC screening, compliance with those guidelines is sub-optimal and disparities remain. In particular, adults who receive care at rural FQHCs that have limited resources struggle to initiate and maintain annual CRC screening via the most common method, FIT. Over the past decade, our team has studied the effectiveness of specific interventions to enhance initial and repeat CRC screening completion among lower income, lower health literate, racial/ethnically diverse adults in rural FQHC settings. The majority of patients will complete the initial test (67% - 69%), yet fewer (32% - 40%) complete an annual test in years 2 and 3. This indicates a ‘stepped care’ approach is needed to promote long-term CRC screening. Our rural health literacy interventions have until now been limited to the FIT due to restrictions of state Medicaid coverage and clinical bandwidth of colonoscopy services available to rural FQHCs. Changes to Medicaid have now expanded the availability of colonoscopy. We now propose a novel intervention guided by evidence learned from our previous studies and recent literature - the Patient-centered Reminders to Inform, Motivate, and Engage-CRC Screening (PRIME-CRC).In our proposed 2-arm, randomized control trial (N=1200), both PRIME-CRC and enhanced usual care arms will receive our health literacy evidence-based practices for delivering CRC patient information and counseling to aid patient decision making for selecting FIT or colonoscopy and simplified test instructions. PRIME-CRC will additionally have a stepped care’ approach for reminding patients on proper CRC screening preparation for scheduled colonoscopy or completion of annual FIT. Patients in the PRIME-CRC arm will have frequent follow-up with tailored contact via automated call or SMS text (based on patient preference) from their healthcare provider (audio recorded or personalized text) .The primary outcome will be completion of either colonoscopy or annual FIT over 3 years. Our specific aims are to: Test the effectiveness of the PRIME-CRC intervention to improve CRC screening completion rates in rural FQHCs compared to enhanced usual care. Investigate whether the intervention can reduce CRC screening disparities by patient health literacy, race or sex. Determine the fidelity, or reliability of PRIME-CRC components, and explore patient, provider, and healthcare system barriers to implementation. Evaluate the cost associated with the intervention from a FQHC perspective. This study extends our team’s longstanding collaboration on health literacy, health disparities, rural health and cancer screening.