Identifying Receipt of Colorectal Cancer Screening

描述（由申请人提供）：结直肠癌（CRC）是美国癌症死亡的第二大原因。定期筛查CRC可导致早期发现，并大幅降低CRC相关的发病率和死亡率。尽管有这些证据，坚持CRC筛查建议仍然很差。鉴于筛查CRC的好处，需要制定干预措施，最终提高其利用率。这些干预措施必须针对从未接受过筛查或目前没有接受筛查的个人，并且必须考虑到风险因素[例如，家族史、炎症性肠病、既往腺瘤史]。应用CRC筛查干预的一个重要障碍是准确快速地识别需要筛查的患者的能力。在我们提出的项目中，我们将创建和评估一个创新的电子数据收集系统，以提高我们对CRC筛查的交付和利用的理解。我们将把附属于范德比尔特大学医学中心的初级保健诊所作为一个试验点，但所开发的方法将是通用的，足以在任何有足够电子记录的地方工作。这个数据收集系统将建立在我们以前的工作，使用知识地图概念标识符（KMCI），这是最初开发的医学课程在范德比尔特大学医学院提取生物医学概念。我们将构建一个以KMCI为核心的工具，以检测CRC筛查的接收情况并提供其背景（例如，个体风险因素，进行CRC测试的时间和结果）。利用电子记录和账单（索赔）记录中的信息，该系统将允许快速准确地识别哪些患者已经和尚未接受CRC筛查测试，并识别那些在筛查测试后需要随访的患者。我们将确定KMCI的测试特征（敏感性，特异性），以识别CRC筛查的接收，并将其与账单记录的自动审查进行比较。我们假设KMCI在检测CRC筛查的接收方面将比自动审查账单记录表现得更好，并将提供有关筛查测试的更丰富的上下文信息。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Regular screening for CRC leads to early detection and a substantial reduction in CRC-related morbidity and mortality. Despite this evidence, adherence to CRC screening recommendations remains poor. Given the benefits of screening for CRC, interventions need to be developed that will ultimately increase its utilization. These interventions must be targeted towards individuals who have never been screened or are not current with their screening, and must take into account risk factors [e.g., family history, inflammatory bowel disease, history of previous adenomas]. A significant barrier to applying CRC screening interventions is the ability to accurately and quickly identify patients in need of screening. In our proposed project, we will create and evaluate an innovative electronic data collection system to enhance our understanding of the delivery and utilization of CRC screening. We will use as a test site the primary care clinics affiliated with Vanderbilt University Medical Center, but the approach developed will be general enough to work wherever adequate electronic records are available. This data collection system will build upon our prior work using the Knowledge Map Concept Identifier (KMCI), which was originally developed to extract biomedical concepts represented in the medical school curriculum at Vanderbilt University School of Medicine. We will build a tool using KMCI as its core to detect receipt of CRC screening and to provide its context (e.g., individual risk factors, which CRC test was performed, when, and the results). Utilizing information from the electronic records and billing (claims) records, this system will allow for rapid and accurate identification of which patients have and have not received CRC screening tests, and for identification of those patients that require follow-up after their screening tests. We will determine the test characteristics of KMCI (sensitivity, specificity) for identifying receipt of CRC screening, and compare this to an automated review of billing records. We hypothesize that KMCI will perform better than an automated review of billing records in detecting receipt of CRC screening, and will provide richer, contextual information regarding the screening tests.