Improving Access to Gastrointestinal Endoscopy in the Covid-19 Recovery Phase and Beyond

改善 Covid-19 恢复阶段及以后接受胃肠内窥镜检查的机会

• 批准号: 10416349
• 负责人: Megan Adkins Adams
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10416349
• 关键词: Acute; Address; Adopted; Adoption; Area; Businesses; COVID-19; COVID-19 pandemic; Caring; Chronic; Colonoscopy; Communities; Data; Data Collection; Development; Diagnosis; Endoscopy; Ensure; Evaluation; Evaluation Reports; Evidence based practice; Feces; Feedback; Foundations; Gastrointestinal Endoscopy; Goals; Grant; Guidelines; Health Services Accessibility; Health system; Healthcare Systems; Improve Access; Intervention; Interview; Leadership; Measurement; Methodology; Methods; Modeling; Monitor; Motivation; Outcome; Patients; Performance; Periodicity; Phase; Population; Preparation; Prevention program; Procedures; Process; Provider; Recovery; Reporting; Resources; Risk; Services; Shock; Site; Solid; System; Testing; Time; Update; Work; adverse outcome; base; colorectal cancer prevention; colorectal cancer risk; colorectal cancer screening; colorectal cancer treatment; coronavirus disease; design; gastrointestinal; implementation design; implementation evaluation; implementation facilitators; implementation strategy; improved; medical specialties; meetings; online repository; pandemic disease; post intervention; post-COVID-19; screening; tool; uptake

Background: Ensuring access to resource-limited specialty care is an ongoing challenge for VHA, and a top priority of VHA, VISN and facility leadership. The COVID-19 pandemic has only exacerbated this challenge, particularly for procedural services. Backlogs are now growing for high-volume gastrointestinal (GI) endoscopic procedures such as colonoscopy, a central component of VHA’s highly successful colorectal cancer (CRC) prevention program. As a result, there are concerns about adverse impacts on downstream outcomes, such as timely diagnosis and treatment of CRC. Thus, there is an urgent need for systematic strategies to ensure ongoing access to colonoscopy in the wake of the pandemic. Replacing average-risk screening colonoscopy with stool-based screening (i.e., fecal immunochemical testing, FIT) is the evidence-based practice (EBP) with the greatest potential to improve endoscopy access without compromising quality. Such tests are guideline- recommended and highly effective, yet underutilized. Despite a March 2020 VACO directive mandating preferential use of FIT over colonoscopy for average-risk CRC screening during the pandemic, many VHA facilities have failed to effectively implement and/or sustain this EBP. We hypothesize that creation, deployment, and facilitated use of an implementation “playbook”—a compendium of multi-level implementation strategies—will optimize and sustain facility-level uptake of FIT-based CRC screening and improve overall colonoscopy access. In this startup proposal, we will partner with VISN 10 to develop and deploy this “playbook,” identify barriers and facilitators to implementation, and refine the measurement and evaluation framework and associated tools necessary to monitor EBP use and track ongoing performance. This work will lay a solid foundation for the full PII proposal focused on multi-site dissemination and evaluation of this EBP as a mechanism to improve overall endoscopy access. Significance/Impact: Optimizing and sustaining uptake of FIT-based screening will not only help VHA address procedural backlogs during the post-COVID recovery period, but more importantly will help VHA to tackle chronic access challenges by decreasing colonoscopy demand and improving overall endoscopy access. Specific Aims: Aim 1: Co-design an implementation “playbook” -- a compendium of strategies to promote optimization and sustainability of FIT-based CRC screening. Aim 2: Pilot the implementation “playbook” at 2 VISN 10 endoscopy facilities, and refine evaluation, data collection, analysis, and reporting plans. Methodology: In Aim 1, we will collaborate with 2 VISN 10 facilities to co-design and refine an implementation “playbook” — an interactive online repository of tools to promote optimization and sustainability of FIT-based screening. The project team will facilitate and encourage the process through periodic meetings, resulting in a compendium of tools targeting the patient-, provider-, and system-levels informed by recognized implementation strategies. In Aim 2, we will pilot the implementation “playbook” at two VISN 10 sites to further refine and adapt the intervention and to identify potential barriers and facilitators to implementation. Each startup facility will implement one or more tools at each level as part of this pilot. Additionally, we will refine our measurement and evaluation framework, including development of evaluation and reporting tools (e.g., interview guides, facility-specific feedback reports) in preparation for the planned full QUERI VISN PII proposal. Implementation/Next Steps: The activities proposed in this startup proposal will lay the foundation for a full QUERI PII proposal focused on multi-site dissemination and evaluation of this EBP as a mechanism to improve overall endoscopy access. Products of this grant will include: (1) An implementation “playbook” that VA facilities can use to enhance uptake of FIT-based screening and decrease colonoscopy demand; (2) evaluation and reporting tools to monitor EBP uptake and sustainability; and (3) a measurement and evaluation framework to support dissemination and evaluation of the intervention to enhance overall endoscopy access.

背景：确保获得资源有限的专业护理是VHA的持续挑战，也是最高的 VHA，VISN和设施领导的优先级。 COVID-19的大流行只会加剧这一挑战， 特别是用于程序服务。积压现在正在为高体积胃肠道（GI）内窥镜增长 诸如VHA非常成功的结直肠癌（CRC）的核心成分之类的程序，例如结肠镜检查。 预防计划。结果，人们担心对下游结果的不利影响，例如 及时的CRC诊断和治疗。这是迫切需要系统的策略来确保 大流行后，持续进入结肠镜检查。取代平均风险筛查结肠镜检查 凭借基于粪便的筛查（即粪便免疫化学测试，FIT）是基于证据的实践（EBP） 在不妥协质量的情况下改善内窥镜通道的最​​大潜力。这样的测试是指南 - 推荐且高效，但未充分利用。尽管有2020年3月的Vaco指令要求 优先使用拟合比结肠镜检查在大流行期间的平均风险CRC筛查，许多VHA 设施无法有效地实施和/或维持此EBP。我们假设这个创造， 部署和准备使用实施“剧本” - 多级实施的汇编 策略 - 将优化和维持基于合适的CRC筛查的设施水平的吸收并改善整体 结肠镜检查。在此初创企业建议中，我们将与Visn 10合作开发和部署 “剧本”，确定实施的障碍和促进者，并完善测量和评估 框架和相关工具，以监视EBP使用和跟踪正在进行的性能。这项工作将 为完整的PII提案奠定坚实的基础 改善整体内窥镜通道的机制。 意义/影响：优化和维持对基于拟合的筛查的吸收不仅有助于VHA地址 在循环后恢复期内的程序积压，但更重要的是，将有助于VHA解决 通过减少结肠镜检查需求并改善整体内窥镜访问，带来了慢性通道挑战。 具体目的：目标1：共同设计实施“剧本” - 促进策略的汇编 基于拟合的CRC筛查的优化和可持续性。 AIM 2：在2中试用实施“剧本” Visn 10内窥镜设施，以及完善评估，数据收集，分析和报告计划。 方法论：在AIM 1中，我们将与2个VISN 10设施合作，以共同设计和完善实施 “ Playbook” - 一个互动的在线存储库，用于促进基于拟合的优化和可持续性的工具 筛选。项目团队将通过定期会议来促进和鼓励该过程，从而导致 针对患者，提供商和系统级别的工具汇编。 实施策略。在AIM 2中，我们将在两个Visn 10个网站上试用实施“剧本”以进一步 完善并适应干预措施，并确定潜在的障碍和促进者进行实施。每个 作为该试点的一部分，启动设施将在每个级别实施一个或多个工具。此外，我们将完善我们的 测量和评估框架，包括开发评估和报告工具（例如， 面试指南，设施特定的反馈报告）准备计划的完整Queri Visn Pii提案。 实施/下一步：本初创企业建议中提出的活动将为完整奠定基础 QUERI PII提案的重点是多站点的传播和评估该EBP作为一种机制 改善总体内窥镜访问。该赠款的产品将包括：（1）实施“剧本” VA设施可以用来增强基于拟合的筛查的吸收并减少结肠镜检查的需求； （2） 评估和报告工具以监控EBP的吸收和可持续性； （3）测量和评估 支持分发和评估干预措施以增强整体内窥镜通道的框架。

项目成果

Development and validation of a new ICD-10-based screening colonoscopy overuse measure in a large integrated healthcare system: a retrospective observational study.

• DOI: 10.1136/bmjqs-2021-014236
• 发表时间: 2023-07
• 期刊: BMJ QUALITY & SAFETY
• 影响因子: 5.4
• 作者: Adams, Megan A.;Kerr, Eve A.;Dominitz, Jason A.;Gao, Yuqing;Yankey, Nicholas;May, Folasade P.;Mafi, John;Saini, Sameer D.
• 通讯作者: Saini, Sameer D.