Developing an intervention to improve follow-up of abnormal fecal immunochemical test results in a safety-net population using a mixed methods approach

项目摘要 Rachel Isabel，医学博士，MAS的长期职业目标是成为一名独立的研究人员和领导者， 制定，实施和评估干预措施，以降低结肠直肠癌（CRC）的死亡率， 服务不足的人群。她已经确定改善异常粪便免疫化学试验（FIT）的随访 成果作为实现这一目标的一个关键问题。该提案描述了一项为期5年的全面 培训和指导研究的健康结果研究的学术生涯计划。研究 该议程符合NCI的五个科学目标之一：改善癌症预防和控制。在这个目标中， 促进医疗服务不足人口的保健公平是一个特别关注的领域。当伊斯雷尔博士 在临床胃肠病学和安全网系统级研究方面有很强的背景，K 08将提供 高级多层次统计建模，定性研究方法，混合方法研究， 干预发展。FIT比结肠镜检查更适合在联邦合格的健康检查中进行CRC筛查 由于患者的偏好和有限的结肠镜资源，结肠镜检查中心（CNOHC）和安全网卫生系统。 对于基于FIT的筛查，以有效降低CRC死亡率，异常结果必须遵循诊断 结肠镜检查然而，联合国卫生组织和安全网卫生系统并不一贯地跟踪异常 FIT结果和未能完成诊断性结肠镜检查会使CRC死亡率增加3倍。研究 表明大约50%的FIT异常的安全网患者没有完成诊断 结肠镜检查结果1年内。这突出了识别和描述障碍的重要性 在FIT结果异常后完成诊断性结肠镜检查，以便制定有效的干预措施。的 研究的具体目标是：（1）使用混合方法，确定潜在的可改变的患者，提供者和诊所- FIT异常患者的诊断性结肠镜检查水平障碍导致大型安全网卫生系统; 以及（2）根据目标1中确定的干预目标，制定试点干预措施，以改善诊断 在FIT结果异常的安全网人群中完成结肠镜检查。Isabel博士的导师团队 包括世界知名的胃肠病学家、卫生服务研究人员、定性和混合方法 专家和执行科学家将提供经验指导，以补充她的教学培训。 除了弗雷德哈钦森癌症研究中心的支持性研究环境外， 中心和华盛顿大学的合作，将使她能够实现拟议的项目目标。完成后 在拟议的研究和培训中，Islam博士将提交一份具有竞争力的R级资助申请，以测试 在随机试验中进行试点干预，并将拥有持续和有效的技能和经验， 通过循证干预措施，改善异常患者的随访， FIT结果。

Project Summary Rachel Issaka, MD, MAS’ long-term career goal is to become an independent researcher and leader in developing, implementing, and evaluating interventions to reduce colorectal cancer (CRC) mortality in medically underserved populations. She has identified improving follow-up of abnormal fecal immunochemical test (FIT) results as a critical issue to address to achieve this goal. This proposal describes a 5-year comprehensive program of training and mentored research for an academic career in health outcomes research. The research agenda is in line with one of NCI’s five scientific goals: to improve cancer prevention and control. In this goal, advancing health care equity in medically underserved populations is an area of special focus. While Dr. Issaka has a strong background in clinical gastroenterology and safety-net systems-level research, this K08 will provide key training in advanced multilevel statistical modeling, qualitative research methods, mixed methods research, and intervention development. FIT is promoted over colonoscopy for CRC screening in federally qualified health centers (FQHCs) and safety-net health systems due to patient preference and limited colonoscopy resources. For FIT-based screening to effectively reduce CRC-mortality, abnormal results must be followed by a diagnostic colonoscopy. However, FQHCs and safety-net health systems do not consistently track follow-up of abnormal FIT results and failure to complete a diagnostic colonoscopy increases CRC-mortality by up to 3-fold. Research suggests approximately 50% of safety-net patients with an abnormal FIT do not complete a diagnostic colonoscopy within 1 year of their result. This highlights the importance of identifying and describing the barriers to diagnostic colonoscopy completion after abnormal FIT results in order to develop effective interventions. The study’s specific aims are: (1) using mixed methods, identify the potentially modifiable patient, provider, and clinic- level barriers to diagnostic colonoscopy in patients with abnormal FIT results in a large safety-net health system; and (2) based upon intervention targets identified in Aim 1, develop a pilot intervention to improve diagnostic colonoscopy completion in a safety-net population with abnormal FIT results. Dr. Issaka’s mentorship team including world-renowned gastroenterologists, health services researchers, qualitative and mixed methods experts and implementation scientists will provide experiential guidance to complement her didactic training. These factors in addition to the supportive research environments at the Fred Hutchinson Cancer Research Center and the University of Washington, will enable her to achieve the proposed project aims. Upon completion of the proposed research and training, Dr. Issaka will submit a competitive R-level grant application to test the pilot intervention in a randomized trial and will possess the skills and experience to make sustained and impactful contributions to reduce CRC-mortality through evidence-based interventions that improve follow-up of abnormal FIT results.