Colorectal Cancer Screening in County Health Centers

描述(由申请人提供) 拟议研究的目标是评估和加强县卫生中心初级保健实践中结直肠癌(CRC)筛查的交付、利用和相关结果。该项目是纽约州立大学石溪分校预防医学部和萨福克县卫生服务部共同努力的结果。其具体目的是测试一种创新的方法，通过互动的继续医学教育(CME)提供者干预，在服务于多种族贫困人口的实践中促进CRC筛查的交付和利用。 CME干预旨在改进提供者的筛查方法、结直肠癌风险沟通、行为咨询以及使用系统方法提供临床预防服务。配对的县卫生中心将被随机分为干预或对照实践，以测试CME干预。建议的变化和筛查的完成将通过对干预前健康中心患者记录的审计来评估。干预前的调查将被用来跟踪提供者知识、态度和自我报告做法的变化。将进一步开发县电脑化患者记录/管理系统，以监测CRC筛查的完成情况，包括跟踪转诊至已建立转诊联系的专科提供者的程序。 将通过一项试点评估来探索CRC风险评估和沟通及其在改善这一人群中患者决策方面的作用。干预前将对随机选择的与卫生中心提供者有关的患者子集进行电话调查。这将检查医生和患者的访问互动，并评估关于CRC测试选项的风险认知、风险咨询和共享决策，以及筛查方法和不良事件的自我报告可接受性。 这项研究将展示实施有组织的结直肠癌筛查交付方法在多大程度上影响为多种族贫困人口服务的初级保健实践中的筛查利用。这项研究的重点是关于影响提供者采用CRC指南和对此类患者进行CRC筛查的建议以及患者决定遵守的重要问题。

DESCRIPTION (provided by applicant) The objective of the proposed research is to assess and enhance colorectal cancer (CRC) screening delivery, utilization, and related outcomes within county health center primary care practices. The project is a collaborative effort between the Department of Preventive Medicine, SUNY at Stony Brook, and the Suffolk County Department of Health Services. The specific aim is to test an innovative approach to promoting CRC screening delivery and utilization within practices serving multiethnic, underprivileged populations, through an interacting continuing medical education (CME) provider intervention. The CME intervention is designed to improve providers' screening methods, CRC risk communication, behavioral counseling, and use of a systems approach to the delivery of clinical preventive services. Matched pairs of county health centers will be randomized into intervention or control practices for testing the CME intervention. Changes in recommendations and completion of screening will be evaluated using an audit of pre-post- intervention health center patient records. Pre-post- intervention surveys will be used to follow changes in provider knowledge, attitudes, and self-reported practices. The county computerized patient record/management system will be further developed for monitoring completion of CRC screening, including tracking procedures referred to specialty providers with established referral linkages. CRC risk assessment and communication and its role in improving patient decision-making among this population will be explored through a pilot evaluation. A pre-post- intervention telephone survey of a subset of randomly selected patients linked to health center providers will be conducted. This will examine the doctor-patient visit interaction and evaluate risk perception, risk counseling, and shared decision-making with respect to CRC test options and self-reported acceptability of screening methods and adverse events. The research will demonstrate the extent to which the implementation of organized approaches to CRC screening delivery influences screening utilization in primary care practices that serve multiethnic, underprivileged populations. The research focuses on important questions regarding factors influencing provider adoption of CRC guidelines and recommendations for CRC screening of such patients, as well as patient decisions to comply.