CARES-REACH (Colorectal Cancer Awareness, Research, Education and Screening-Rural Expansion, Access and Capacity for Health)

摘要 尽管2020年健康人群的目标是70.5%，但在联邦政府合格人群中， 保健中心约占40%。拟议的研究旨在解决这一差距，并加快 采取有效的癌症预防和控制检查措施，以推广CRC检查。 利用我们建立的社区学术网络，强调参与性的方法， 社区，临床和学术利益相关者，我们建立在我们广泛的预备研究，测试了 低识字率教育干预加粪便免疫化学测试[FIT]），并导致初始 筛查率达80%。这项工作主要在城市环境中进行。此前的研究表明， 重复FIT筛查率通常在没有干预的情况下显着下降，并且存在显著的地理差异。 相关的CRC差异与农村地区个人的死亡率较高有关。更多的研究 需要解决重复筛查问题，并将我们的覆盖范围扩大到其他高危人群和农村人口。通知 一个基于社区的参与式研究（CBPR）框架，并通过实施科学来丰富 CARES-REACH采用阶梯式楔形设计，带有用于维护的延伸部分， 实施战略侧重于多个层面：组织、提供者和患者层面， 在平均风险和符合年龄条件的成年人中加强初始和重复筛查的过程。这种多层次 一项研究需要实施一套核心的循证干预措施，包括： 患者教育（英语、西班牙语和海地克里奥尔语）;提供者教育，全系统电子 医疗记录（EMR）工具和提示，FIT分发以及组织范围内的癌症控制 激励提供者、引导患者并监测系统范围内的筛查活动的倡导者。 具体目标是：1）实施一个组织范围内的多层次CRC干预使用EBI加上癌症 位于佛罗里达中部和西南部农村和城市的BHCs的控制冠军; 2）探索是否 实践环境和人群特征可能会对年度临床CRC统一数据系统产生不同影响 (UDS)筛查率; 3）对实施过程进行全面评估（促进者 和障碍），资源需求，和中间病人的结果，为该计划在CIMHC 组织的干预措施将在诊所之间逐步推广：一组诊所 接受早期干预推广，其他诊所推迟，以便进行严格的比较。主要 结果是与前一年的CRC筛查率相比， 每个诊所的筛查率，并比较早期推出诊所与延迟推出诊所之间的筛查率。 解决执行过程将指导和指导扩大到其他社区卫生协调中心和社区卫生 系统.

ABSTRACT Despite the Healthy People 2020 goal of 70.5%, colorectal cancer (CRC) screening rates in Federally Qualified Health Centers (FQHCs) are about 40%. The proposed study seeks to address this disparity and accelerate the adoption of effective cancer prevention and control screening practices to promote CRC screening. Leveraging our established community-academic network, which emphasizes participatory approaches among community, clinical, and academic stakeholders, we build on our extensive preparatory research that tested a low-literacy educational intervention plus Fecal Immunochemical Test [FIT]), and which resulted in initial screening rates of 80%. This work was primarily carried-out in urban-based settings. Prior research shows that repeat FIT screening rates often drop significantly without intervention and that there are notable geographic related CRC disparities with higher mortality seen among individuals in rural areas. Additional research is needed to address repeat screening and expand our reach to other at-risk and rural populations. Informed by a community-based participatory research (CBPR) framework and enriched by implementation science approaches, CARES-REACH features a stepped wedge design with extension for maintenance to support an implementation strategy focused on multiple levels: organizational, provider, and patient level that entail processes to boost initial and repeat screening among average risk and age-eligible adults. This multilevel study entails implementation of a core set of evidence-based interventions (EBIs) that include: low literacy patient education (English, Spanish, and Haitian Creole language); provider education, system-wide electronic medical record (EMR) tools and prompts, and FIT distribution plus an organization-wide cancer control champion who motivates providers, navigates patients, and monitors system-wide screening activities. Specific aims are to: 1) implement an organization-wide multilevel CRC intervention using EBIs plus a cancer control champion in FQHCs located in rural and urban Central and Southwest Florida; 2) explore whether practice setting and population characteristics may differentially impact annual clinic CRC uniform Data system (UDS) screening rates; and 3) conduct a comprehensive evaluation of the implementation process (facilitators and impediments), resource requirements, and intermediate patient outcomes for the program in FQHC organizations. The intervention will be rolled out in a stepwise-method across clinics: one group of clinics receives early intervention roll-out and the other clinics are delayed to allow for rigorous comparison. The main outcome is change in annual clinic CRC screening rates compared to CRC screening rates of the prior year for each clinic as well as comparing screening rates among early roll-out clinics vs. delayed roll-out clinics. Addressing implementation processes will guide and direct scale-up to other FQHCs and community health systems.