Bridging the gap: Delivering Equitable Colorectal Cancer Screening

总结 结直肠癌（CRC）是美国第三大常见的癌症和癌症死亡原因，与 在历史上被边缘化的人群中，结果存在显著差异。黑人最高 CRC的死亡率;一半的差异与较低的筛查率有关。CRC筛查是 由美国咨询服务工作组推荐给45-75岁的成年人。病人导航 是一项以证据为基础的战略，旨在提高少数种族和族裔的筛查率。而患者 导航是一种循证方法，以提高筛选，在理解多层次的差距 影响这些方案在初级保健实践中的实施，特别是使用健康- 以股权为中心，以股东为中心的方法。我们的长期目标是通过以下方式促进健康公平： 理解背景因素，包括制度和人际种族主义以及实施战略 需要在不同种族和民族人群的初级保健环境中实施患者导航。 我们提出混合方法，沿着由社区组织组成的咨询委员会， 调整患者导航干预，以考虑患者人群、临床工作流程和人员配备， 和社区背景。实用、稳健的实施和可持续发展模型（PRISM） 以及核心健康和种族平等原则，我们的目标是增加患者导航和显示的覆盖范围。 通过提高黑人和西班牙裔患者完成CRC的百分比来提高疗效 筛选我们还将利用对执行战略的纵向跟踪，更好地跟踪执行情况 或干预调整导航交付，以便为未来的规模扩大提供信息。我们将进行一个逐步- 在15家诊所开展患者导航以及患者和提供者提醒的楔形随机试验（3 每步诊所，5个6个月的步骤）。实施战略将包括评估准备情况、审计和 反馈，建立社区联盟，吸引消费者，修改推荐跟踪，以及培训和 教育临床利益相关者。我们将在使用电子健康记录数据时考虑 观察性医学结局伙伴关系（OMOP）通用数据模型，其他患者报告数据， 并研究跟踪日志，以衡量覆盖范围，有效性，采用率，实施（保真度，可行性， 可接受性、适当性），并将使用定性措施和现场观察记录 背景因素，包括检查患者经历和提供者转诊模式中的歧视 可能影响干预实施或CRC筛查完成。与国家委员会的伙伴关系 质量保证（NCQA）将进一步让我们研究社区参与模式的可持续性， 提供循证干预措施。

Summary Colorectal cancer (CRC) is the third most common cause of cancer and cancer mortality in the U.S., with significant differences in outcomes in historically marginalized populations. Black individuals have the highest mortality rate for CRC; half of the disparity has been associated with lower screening rates. CRC screening is recommended by the United States Preventative Services Task Force for adults age 45-75. Patient navigation is an evidence-based strategy to increase screening rates among racial and ethnic minorities. While patient navigation is an evidence-based approach to improve screening, there is a gap in understanding the multi-level influences on implementation of such programs across primary care practices, particularly using a health- equity focused, stakeholder-centered approach. Our long-term goal is to promote health equity through understanding contextual factors including system and interpersonal racism and implementation strategies needed to implement patient navigation across primary care settings with diverse racial and ethnic populations. We propose mixed methods along with an advisory board comprised of community organizations to iteratively adapt the patient navigation intervention to consider the patient population, the clinical workflows and staffing, and the community context. Guided by the Practical, Robust Implementation and Sustainability Model (PRISM) and core health and racial equity principles, we aim to increase reach of patient navigation and show effectiveness through improvement in the percentage of Black and Hispanic patients completing CRC screening. We will also utilize longitudinal tracking of implementation strategies to better track implementation or intervention adaptations navigation delivery in order to inform future scale up. We will conduct a stepped- wedged, randomized trial to roll out patient navigation and patient and provider reminders across 15 clinics (3 clinics per step, 5 six-month steps). Implementation strategies will include assessing for readiness, audit and feedback, building a community coalition, engaging consumers, modifying referral tracking, and training and educating clinical stakeholders. We will use the electronic health record data with consideration for the Observational Medical Outcomes Partnership (OMOP) Common Data Model, additional patient-reported data, and study tracking logs to measure reach, effectiveness, adoption, implementation (fidelity, feasibility, acceptability, appropriateness), and will use qualitative measures and site observations to document contextual factors, including examination of discrimination in patient experiences and provider referral patterns that may influence intervention delivery or CRC screening completion. Partnership with the National Committee on Quality Assurance (NCQA) will further allow us to examine sustainability of a community-engaged model for delivery of evidence-based interventions.