Implementing evidence based colorectal cancer screening in rural clinics

项目摘要/摘要 在美国，结直肠癌(CRC)仍是导致53,200人死亡的第三大常见癌症原因 预计在2021年死亡，尽管这一数字可以通过适当的筛查大大减少。1 与城市同龄人相比，生活在农村地区的人患糖尿病的几率要高出50%。 在美国农村地区，CRC(OR 1.50，CI：1.43-1.57)和35%的死亡率(OR 1.35，CI：1.26-1.45)更高 远低于全国结直肠癌圆桌会议的CRC筛查目标80%。2-4-5同样糟糕 粪便免疫试验(FIT)阳性结果的解决结果是，8%的患者出现这种情况 患者最初测试为Fit。只有50%到55%的人具有积极的契合度结果 诊断性结肠镜检查。7-11 增加结直肠癌筛查的最有效方法之一是循证干预(EBI)。 结合邮寄(FIT)和患者导航(PN)。12不幸的是，这种EBI在农村地区的实施 设置是有限的。因此，为了响应确定克服障碍的战略的呼吁， 循证干预(PAR-19-274)，我们将评估捆绑促进的有效性 实施战略，增加EBI在结直肠癌筛查中的应用。我们的目标是支持建模 有必要指导今后在农村诊所开展结直肠癌筛查的EBI。 在目标1中，我们将评估实施EBI以改进CRC筛查和诊断的能力 结肠镜率，定义为通过实施EBI完成筛查事件(有效性) 在印第安纳州的农村进行结直肠癌筛查。我们假设结直肠癌筛查的完整筛查插曲(FIT 或筛查结肠镜)，包括阳性配合后的结肠镜诊断摄取，将会更高 实施EBI后，与基线(通常的护理)相比，在整个维护过程中。 诊断性结肠镜检查的分辨率和FIT的重复筛查将作为探索性处理 结果。在目标2中，我们将评估背景因素(创新、接受者、内部和外部)的变化 背景)、执行战略和执行成果(REACH和执行)，使用混合 数据(定性访谈和量化措施)，以建立9个乡村诊所的实施概况。 在目标3中，我们估计部署执行战略和 乡村诊所流程，并评估实施和维持《儿童权利公约》的成本效益 筛查干预。

Project Summary/Abstract Colorectal cancer (CRC) remains the third most common cause of cancer mortality in the US with 53,200 deaths expected in 2021, even though this number could be greatly reduced through appropriate screening.1 Compared to their urban counterparts, individuals living in rural areas experience a 50% higher incidence of CRC (OR 1.50, CI:1.43-1.57) and 35% higher mortality (OR 1.35,CI: 1.26-1.45), with rural segments of the US falling far below the National Colorectal Cancer Roundtable CRC screening goal of 80%.2-4-5 Equally poor results are found for the resolution of a positive fecal immunological test (FIT) result, which occurs in 8% of all patients initially tested with FIT. Only 50 to 55% of individuals with positive FIT results follow through with a diagnostic colonoscopy.7-11 One of the most effective approaches to increasing CRC screening is an evidence-based intervention (EBI) combining a mailed (FIT) and patient navigation (PN).12 Unfortunately, implementation of this EBI in rural settings is limited. Thus, in response to the call to identify strategies for overcoming barriers to the adoption of evidence-based interventions (PAR-19-274), we will evaluate the effectiveness of bundled facilitation implementation strategies to increase uptake of EBI’s for CRC screening. Our aims support the modeling necessary to guide future implementation of the EBI for CRC screening in rural clinics. In Aim 1, we will evaluate the ability of an implementation of an EBI to improve CRC screening and diagnostic colonoscopy rates, defined as completed screening episode (effectiveness) through implementation of an EBI for CRC screening in rural Indiana. We hypothesize that a complete screening episode of CRC screening (FIT or screening colonoscopy), including diagnostic colonoscopy uptake following positive FIT, will be higher following implementation of an EBI and throughout maintenance compared to baseline (usual care). Resolution with diagnostic colonoscopy and repeat screening with FIT will be handled as exploratory outcomes. In Aim 2 we will evaluate the variation in contextual factors (innovation, recipient, inner and outer context), implementation strategies and implementation outcomes (reach and implementation) using mixed data (qualitative interviews and quantitative measures) to build implementation profiles of nine rural clinics. In Aim 3, we estimate the cost and budget impact of the deployment of implementation strategies and processes for rural clinics and evaluate the cost-effectiveness of implementing and sustaining the CRC screening intervention.