Increasing Access and Developing Predictors for Colorectal Cancer Screening for Minority and Medicaid Clients

摘要 非裔美国人的结直肠癌发病率比其他人高22%，死亡率比其他人高49% 民族/种族群体。同样，较低的社会经济地位(SES)也与较高的CRC发病率相关 和死亡率。这两个群体在医疗补助人口中的比例都过高。筛查结肠镜是一种 成本效益高的癌症预防和控制战略，导致预防儿童权利委员会(例如，消除 癌前息肉)，更早的CRC检测，因此更高的存活率。对于更喜欢或 由于需要替代品，粪便检测是可靠的替代品(例如，Fit)。然而，许多个人和 结构性障碍往往会降低客户对筛查指南的遵守程度，从而导致“护理差距”的增加 医疗费用和较低的医疗保险质量指标(例如Medicare Star和HEDIS®评分) 公司和供应商。投保的、不遵守规定的患者被认为是保险公司的战略优先事项。这个 证人关怀有限责任公司的使命是通过促进医疗保健的使用来帮助改善人们的生活。这个 将在STTRI阶段研究中开发的产品是一套专门的服务和电子原型 工具(即WC服务)根据我们的行为优化和预测针对Medicaid客户的CRC筛查 通过非营利性组织进行研究、干预开发和交付。我们将提供 为参保客户终端用户提供个性化、文化/种族定制的服务，同时提高全国 医疗保险公司和医疗保健提供商客户的指标和经济高效的访问。这个 技术创新是开发基于计算机的评估工具(即筛选参与度 模型)允许我们根据客户偏好定制消息传递和筛查测试的类型(FIT或结肠镜检查)， 目标是提高这些客户的筛查率，并减少胃肠道疾病的结肠镜检查缺失率 设施。这一产品的成功开发将减少健康保险公司的医疗保健缺口，并缩小差距 在CRC死亡率方面。为了取得进展，我们需要1)证明该产品可以在外部交付 个人临床设置并显著减少护理差距；以及2)开发预测模型 确定哪些患者最好是导航到结肠镜检查而不是粪便检查。这样做的目的是 第一阶段的应用是证明WC服务的可行性和小规模试点效果，以增加CRC 放映。我们提出了以下具体目标：目标1：测试WC服务实现CRC的可行性 对未遵守医疗补助计划的客户进行筛查。里程碑1a：实现结肠镜检查或粪便筛查 至少联系了200名患者中的130名(65%)。里程碑1b：生产新的原型以在第二阶段进行测试。 目的2：开发一种预测结直肠癌筛查结果的算法。里程碑2a：基于以下方面开发模型 现有的R01数据可以预测意向和CRC筛查行为。里程碑2b：将此R01模型修改为 从接触的80%的客户(n=160)处收集的新措施，以确定粪便测试的可能性 五、结肠镜检查完成。里程碑2c：将修订后的原型开发为完整的WC服务产品。

ABSTRACT African Americans have 22% higher incidence and 49% higher death rates from CRC than any other ethnic/racial group. Similarly, lower socioeconomic status (SES) is also associated with higher CRC incidence and mortality. Both of these groups are overrepresented in Medicaid populations. Screening colonoscopy is a cost-effective cancer prevention and control strategy, leading to CRC prevention (e.g., removal of precancerous polyps), earlier CRC detection and therefore higher survival rates. For patients preferring or needing alternatives, fecal tests are reliable alternatives (e.g., FIT). However, numerous individual and structural barriers often reduce client adherence to screening guidelines resulting in “gaps in care,” increasing costs of treatment and lower quality metrics (e.g., Medicare Star and HEDIS® scores) for the health insurance companies and providers. Insured, non-adherent patients are considered a strategic priority for insurers. The mission of Witness CARES, LLC, is to help improve people's lives by facilitating use of health care. The product to be developed in this STTR Phase I study is a specialized set of services and electronic prototype tool (i.e., WC Services) to optimize and predict CRC screening for Medicaid clients based on our behavioral research, intervention development and delivery through a not-for-profit organization. We will provide personalized, culturally/racially-customized services for insured client end-users while improving national metrics and cost-effective access for the health insurance company and health care provider customers. The technological innovation is development of a computer-based assessment tool (i.e., Screening Engagement Model) allowing us to tailor messaging and type of screening test (FIT or colonoscopy) to client preferences, with the goal of increasing rates of screening for these clients and reducing colonoscopy no-shows for GI facilities. Successful creation of this product will reduce gaps in care for health insurers and reduce disparities in CRC mortality. To move forward, we need to 1) prove that this product can be delivered outside an individual clinical setting and significantly reduce gaps in care; and 2) develop a predictive model for determining which patients are best served by navigation to colonoscopy versus a stool test. The goal of this Phase I application is to prove the feasibility and small scale pilot efficacy of WC Services to increase CRC screening. We propose the following specific aims: Aim 1: Test the feasibility of WC Services to achieve CRC screening for non-adherent Medicaid clients. Milestone 1a: Achieve either colonoscopy or stool screening by a minimum of 130 of 200 (65%) patients contacted. Milestone 1b: Produce a new prototype to test in Phase II. Aim 2: Develop an algorithm for predicting CRC screening outcomes. Milestone 2a: Develop models based on existing R01 data to predict intent and CRC screening behaviors. Milestone 2b: Revise this R01 model with new measures collected prospectively from 80% of clients contacted (n=160) to identify likelihood of stool test v. colonoscopy completion. Milestone 2c: Develop a revised prototype into a complete WC Services product.