Developing an intervention to improve follow-up of abnormal fecal immunochemical test results in a safety-net population using a mixed methods approach

项目摘要 Rachel Issaka，医学博士，MAS的长期职业目标是成为一名独立的研究员和领导者 制定、实施和评估降低结直肠癌(CRC)医学死亡率的干预措施 服务不足的人群。她已经确定了改善对异常粪便免疫化学测试(FIT)的随访 成果是实现这一目标需要解决的一个关键问题。这份提案描述了一项为期5年的全面 为健康结果研究的学术生涯提供培训和指导研究的计划。这项研究 议程符合NCI的五个科学目标之一：改善癌症预防和控制。在这个目标中， 在医疗服务不足的人群中促进卫生保健公平是一个特别关注的领域。虽然伊萨卡博士 在临床胃肠病学和安全网系统水平的研究方面有很强的背景，K08将提供 高级多水平统计建模、定性研究方法、混合方法研究、 和干预性发展。FIT在联邦合格健康人群中用于结直肠癌筛查优于结肠镜检查 由于患者的偏好和有限的结肠镜检查资源，医疗中心(FQHC)和安全网卫生系统。 对于有效降低结直肠癌死亡率的基于适合度的筛查，异常结果之后必须进行诊断 结肠镜检查。然而，FQHC和安全网卫生系统并不一致地跟踪异常的后续情况 合适的结果和未能完成结肠镜检查会使结直肠癌死亡率增加3倍。研究 建议大约50%的配合度异常的安全网患者没有完成诊断 结肠镜检查结果的1年内。这突出了识别和描述障碍的重要性 对结肠镜检查完成后的异常配合结果进行诊断，以制定有效的干预措施。这个 研究的具体目标是：(1)使用混合方法，确定潜在的可修改的患者、提供者和临床- 诊断结肠镜检查的水平障碍导致异常匹配的患者形成一个庞大的安全网卫生系统； 以及(2)基于目标1中确定的干预目标，开发试点干预以提高诊断性 在符合异常结果的安全网人群中完成结肠镜检查。伊萨卡博士的导师团队 包括世界知名的胃肠病专家、健康服务研究人员、定性和混合方法 专家和实施科学家将提供经验指导，以补充她的教学培训。 这些因素加上弗雷德·哈钦森癌症研究中心的支持性研究环境 中心和华盛顿大学的合作，将使她能够实现拟议的项目目标。完工后 在拟议的研究和培训中，Issaka博士将提交一份竞争性的R级拨款申请，以测试 随机试验中的飞行员干预，并将拥有持续和有效的技能和经验 通过循证干预改善对异常情况的跟踪，为降低结直肠癌死亡率作出贡献 拟合结果。

Project Summary Rachel Issaka, MD, MAS’ long-term career goal is to become an independent researcher and leader in developing, implementing, and evaluating interventions to reduce colorectal cancer (CRC) mortality in medically underserved populations. She has identified improving follow-up of abnormal fecal immunochemical test (FIT) results as a critical issue to address to achieve this goal. This proposal describes a 5-year comprehensive program of training and mentored research for an academic career in health outcomes research. The research agenda is in line with one of NCI’s five scientific goals: to improve cancer prevention and control. In this goal, advancing health care equity in medically underserved populations is an area of special focus. While Dr. Issaka has a strong background in clinical gastroenterology and safety-net systems-level research, this K08 will provide key training in advanced multilevel statistical modeling, qualitative research methods, mixed methods research, and intervention development. FIT is promoted over colonoscopy for CRC screening in federally qualified health centers (FQHCs) and safety-net health systems due to patient preference and limited colonoscopy resources. For FIT-based screening to effectively reduce CRC-mortality, abnormal results must be followed by a diagnostic colonoscopy. However, FQHCs and safety-net health systems do not consistently track follow-up of abnormal FIT results and failure to complete a diagnostic colonoscopy increases CRC-mortality by up to 3-fold. Research suggests approximately 50% of safety-net patients with an abnormal FIT do not complete a diagnostic colonoscopy within 1 year of their result. This highlights the importance of identifying and describing the barriers to diagnostic colonoscopy completion after abnormal FIT results in order to develop effective interventions. The study’s specific aims are: (1) using mixed methods, identify the potentially modifiable patient, provider, and clinic- level barriers to diagnostic colonoscopy in patients with abnormal FIT results in a large safety-net health system; and (2) based upon intervention targets identified in Aim 1, develop a pilot intervention to improve diagnostic colonoscopy completion in a safety-net population with abnormal FIT results. Dr. Issaka’s mentorship team including world-renowned gastroenterologists, health services researchers, qualitative and mixed methods experts and implementation scientists will provide experiential guidance to complement her didactic training. These factors in addition to the supportive research environments at the Fred Hutchinson Cancer Research Center and the University of Washington, will enable her to achieve the proposed project aims. Upon completion of the proposed research and training, Dr. Issaka will submit a competitive R-level grant application to test the pilot intervention in a randomized trial and will possess the skills and experience to make sustained and impactful contributions to reduce CRC-mortality through evidence-based interventions that improve follow-up of abnormal FIT results.