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

摘要 尽管2020年健康人的目标是70.5%，但联邦合格的结直肠癌(CRC)筛查率 健康中心(FQHC)约占40%。拟议的研究旨在解决这一差距并加快 采用有效的癌症预防和控制筛查做法，促进结直肠癌筛查。 利用我们建立的社区-学术网络，该网络强调 社区、临床和学术利益相关者，我们建立在我们广泛的准备研究的基础上，这些研究测试了 低识字率教育干预加上粪便免疫化学检测[FIT])，导致了最初的 筛查率达80%。这项工作主要在以城市为基础的环境中进行。先前的研究表明， 在没有干预的情况下，重复匹配筛查率通常会显著下降，而且有明显的地理因素 与儿童权利公约相关的差距，在农村地区的个人中出现了较高的死亡率。更多研究是 需要解决重复筛查问题，并将我们的覆盖面扩大到其他高危人群和农村人口。通知人 基于社区的参与性研究(CBPR)框架，并以实施科学为基础 Approach，CARE-REACH采用阶梯式楔形设计，可扩展维护以支持 实施战略侧重于多个层面：组织、提供商和患者层面 促进在平均风险和符合年龄的成年人中进行初次和重复筛查的程序。这个多层次的 研究需要实施一套核心的循证干预措施(EBI)，其中包括：识字率低 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、引导患者并监控全系统筛查活动的倡导者。 具体目标是：1)使用EBIS和癌症实施组织范围内的多水平CRC干预 在位于佛罗里达州中部和西南部农村和城市的FQHC中获得控制冠军；2)探索 实践设置和人口特征可能对年度临床CRC统一数据系统产生不同的影响 (UDS)筛查率；以及3)对执行进程进行全面评估(主持人 和障碍)、资源需求和FQHC计划的中间患者结果 组织。干预措施将以循序渐进的方式在多个诊所之间展开：一组诊所 接受早期干预推出，其他诊所被推迟，以便进行严格的比较。主 结果是每年临床结直肠癌筛查率与前一年结直肠癌筛查率相比的变化 并比较早期推出的诊所和延迟推出的诊所之间的筛查率。 解决实施流程将指导和指导其他FQHC和社区卫生方面的扩展 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.