CRC-HUB-SPOKE: A ColoRectal Cancer screening Hub for Southern California community health centers.

结直肠癌（CRC）筛查和适当的随访可以降低发病率和死亡率。美国 预防服务工作组（USPSTF）建议通过各种侵入性和非侵入性的CRC筛查 测试对象为50至75岁的人。循证干预措施和其他战略 目前存在促进儿童权利公约筛查的措施，但这些措施的采用和实施有限，特别是在社区卫生中心。 我们的假设是，轴辐式多层次干预将上级常规护理。该中心将 南加州健康质量合作伙伴（HQP），一个由16个CHC系统组成的非营利组织 （辐条），为135个农村和城市诊所站点提供服务。我们建议分两个阶段进行试验和优化研究（第一阶段） 并严格测试（第二阶段）中心辐射方法及其对CRC筛查，随访和 常规护理UG 3规划/探索阶段AIM：对可行性、可接受性和初步 使用混合方法进行CRC筛查、随访和从患者到护理的多层次干预的结果 方法论。干预措施包括以HQP中心为基础，向患者集中邮寄FIT 由单独的社区卫生中心-辐条加上免费的提供者和社区卫生中心的诊所级干预提供服务， 协调CHC为异常FIT随访提供的标准化导航策略。UH3 实施阶段。我们将进行一项2组实用的随机试验，以评估 区域发展的多层次干预措施，以增加CRC筛查、随访和患者到护理 CHC患者中。试验将遵循务实、稳健实施和可持续性原则 模型（PRISM），其中包括范围，有效性，采用，实施， 维护（RE-AIM）框架，并将其扩展为上下文结构。目标1.评估有效性 多层次干预的基础是：1）3年后筛查的最新比例改善 实施; 2）在6个月内完成诊断性结肠镜检查的FIT异常比例;以及3） 完成首次治疗评价的CRC比例。目标2.评估实施、可伸缩性和 多层次执行战略的可持续性。将采用混合方法对实施情况进行评估 使用RE-AIM的覆盖、采用和实施结果以及PRISM的方法 从多个利益相关者的角度构建干预特征和接受者（即 患者、一线工作人员和业务负责人）。我们还将计算复制成本。可扩展性和 将使用RE-AIM维护结果和PRISM结构评估可持续性， 实施和可持续性基础设施和外部环境。我们的研究将有助于加速 通过确定多层次干预策略， 可扩展到该地区的其他社区卫生中心，并有可能进行更大规模的实施。

Colorectal cancer (CRC) screening and appropriate follow-up can reduce incidence and mortality. The US Preventive Services Task Force (USPSTF) recommends CRC screening through a variety of invasive and non-invasive tests for individuals aged 50 to 75 years. Evidence-based interventions (EBIs) and other strategies exist to promote CRC screening, but adoption and implementation of these are limited, especially in CHCs. Our hypothesis is that a Hub and Spoke multilevel intervention will be superior to usual care. The hub will be Health Quality Partners of Southern California (HQP), a non-profit organization comprised of 16 CHC systems (spokes), serving 135 rural and urban clinic sites. We propose a 2-phase study to pilot and optimize (Phase I) and rigorously test (Phase II) the Hub and Spoke approach and its impact on CRC screening, follow-up, and usual care. UG3 Planning/Exploratory Phase AIM: Pilot test the feasibility, acceptability, and preliminary outcomes of a multilevel intervention for CRC screening, follow-up, and referral-to-care using a mixed methods approach. The intervention includes HQP hub-based delivery of centralized mailed FIT to patients served by individual CHCs-spokes plus complimentary provider and clinic-level interventions at CHCs, and coordination of a standardized navigation strategy delivered by CHCs for abnormal FIT follow-up. UH3 Implementation Phase. We will conduct a 2-arm pragmatic randomized trial to assess impact of a regionally-developed multilevel intervention to increase CRC screening, follow-up, and referral-to-care among CHC patients. The trial will be guided by the Pragmatic, Robust Implementation and Sustainability Model (PRISM), which includes outcomes from the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and expands them with contextual constructs. Aim 1. Assess effectiveness of the multilevel intervention based on: 1) improvement in proportion up-to-date with screening 3 years post implementation; 2) proportion with abnormal FIT who complete diagnostic colonoscopy within 6 months; and 3) proportion with CRC completing first treatment evaluation. Aim 2. Evaluate the implementation, scalability, and sustainability of a multilevel implementation strategy. Implementation will be evaluated with a mixed methods approach using the RE-AIM outcomes of Reach, Adoption, and Implementation as well as the PRISM constructs of Intervention Characteristics and Recipients from perspective of multiple stakeholders (i.e. patients, front-line staff, and operational leaders). We will also calculate replication costs. Scalability and Sustainability will be evaluated using the RE-AIM outcome of Maintenance and the PRISM constructs of Implementation & Sustainability Infrastructure and External Environment. Our study will help accelerate progress in CRC prevention in underserved populations by identifying multilevel intervention strategies that are scalable to additional CHCs in the region, with potential for larger scale implementation.