Screening More patients for CRC through Adapting and Refining Targeted Evidence-based Interventions in Rural settings (SMARTER CRC)

通过在农村环境中调整和完善有针对性的循证干预措施（SMARTER CRC），筛查更多的 CRC 患者

• 批准号: 10470250
• 负责人: GLORIA D CORONADO
• 金额: $ 108.22万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-23 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10470250
• 关键词: Address; Adoption; Adult; Cancer Etiology; Caring; Cessation of life; Clinic; Colonoscopy; Colorectal Cancer; Communities; Community Healthcare; Data; Educational workshop; Effectiveness; Endoscopy; Evidence based intervention; Feasibility Studies; Geographic Locations; Goals; Health; Health Status; Health system; Hispanic; Home; Infrastructure; Institution; Intervention; Interview; Learning; Location; Logistics; Maintenance; Malignant Neoplasms; Measures; Medicaid; Methods; Modality; Modeling; Native Americans; Oregon; Patients; Persons; Phase; Pilot Projects; Policies; Population; Primary Health Care; Provider; Research; Research Methodology; Risk Factors; Rural; Rural Community; Rural Population; Sample Size; Testing; Trainers Training; Training; Training Programs; Training Support; Translations; Underserved Population; United States; Use Effectiveness; Vendor; acceptability and feasibility; aged; cancer health disparity; care coordination; care outcomes; colon cancer patients; colorectal cancer screening; community-level factor; design; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; experience; feasibility testing; follow-up; frontier; frontier counties; health care availability; health care disparity; health disparity; health plan; implementation evaluation; implementation facilitation; implementation intervention; implementation study; implementation trial; improved; learning strategy; mortality; multi-component intervention; multidisciplinary; organizational readiness; outreach; patient engagement; patient outreach; patient registry; pilot test; practice-based research network; pragmatic trial; prevent; program dissemination; programs; recruit; rural area; rural counties; rural environment; rural setting; rural underserved; scale up; screening; screening disparities; success; tool; urban area; webinar

PROJECT SUMMARY/ABSTRACT: This two-phase project is designed to achieve the Cancer Moonshot objectives by reducing the burden of CRC on the US population. Specifically, we aim to improve CRC screening rates, follow-up colonoscopy, and referral to care in rural Medicaid patients by implementing a direct mail fecal testing program with targeted outreach and patient navigation for follow-up colonoscopy. We leverage partnerships with the Oregon Rural Practice-based Research Network (ORPRN), Kaiser Northwest Center for Health Research, and Medicaid Health Plans and deliver training and implementation support to participating rural primary care clinics using practice facilitation. In total, we anticipate working with 30 organizations to facilitate implementation with 130 primary care clinics (reaching 17,000+ rural Medicaid patients). In Phase I (Year 01), we will conduct a milestone driven pilot to build the necessary infrastructure for a large-scale implementation-effectiveness trial, including adapting the clinic-health plan-vendor supported direct mail program for rural Medicaid patients that have not established care and/or never been screened; conducting a pilot study testing the feasibility and acceptability of patient navigation to support follow-up colonoscopy following an abnormal fecal test; engaging Medicaid Health Plans and recruiting 30 primary care clinics located in rural and frontier counties in Oregon; and developing the training and support materials needed to implement a large-scale trial in these settings. In Phase II (Years 02-05), we will conduct an implementation-effectiveness study using a quasi- experimental stepped wedge design in 30 rural primary care clinics using program training and practice facilitation to support implementation. As in the pilot, the intervention combines: (1) a clinic-health plan- vendor supported direct-mail fecal testing program with targeted outreach for patients who have never been screened or who have yet to establish care and (2) patient navigation for those who are referred for colonoscopy as either the primary screening or for follow-up from an abnormal fecal test. We will evaluate effectiveness, implementation, and maintenance of the intervention through quantitative and qualitative measures. Results from the implementation study will inform scale-up of the program through partnerships with 20 regional and national organizations that serve rural/frontier primary care clinics using webinars, train-the-trainer workshops and collaborative learning activities using the ECHO (Extension for Community Healthcare Outcomes) model.

项目摘要/摘要： 这个两阶段的项目旨在通过减轻负担来实现癌症的月球目标 美国人口的CRC。具体而言，我们旨在提高CRC筛查率，随访 结肠镜检查，并通过实施直接邮件粪便测试来转诊农村医疗补助患者的护理 具有针对性的外展和患者导航的程序进行后续结肠镜检查。我们利用 与俄勒冈农村实践研究网络（ORPRN）的合作伙伴关系，Kaiser Northwest 健康研究中心和医疗补助健康计划，并提供培训和实施 支持参与的农村初级保健诊所使用实践便利。总共，我们预计 与30个组织合作，促进130个初级保健诊所的实施 （达到17,000多名农村医疗补助患者）。 在第一阶段（01年）中，我们将进行里程碑式驱动的飞行员，以建立必要的基础设施 大规模实施效应试验，包括改编临床健康计划供应商 支持未建立护理和/或从未建立护理的农村医疗补助患者的直接邮件计划 被筛选了；进行试验研究，以测试患者导航的可行性和可接受性 粪便检查异常后支持随访结肠镜检查；参与医疗补助健康计划，并 招募位于俄勒冈州农村和边境县的30个初级保健诊所；并开发 在这些情况下实施大规模试验所需的培训和支持材料。 在II阶段（02-05年）中，我们将使用准级进行实施效应研究 使用计划培训和实践的实验性梯级楔形设计在30个农村初级保健诊所 支持实施的促进。与试点一样，干预措施结合了：（1）临床健康计划 - 供应商支持直接邮件粪便测试计划，并针对从未有针对性的外展 被筛选或尚未建立护理以及（2）被推荐的人的患者导航 对于结肠镜检查，作为主要筛查或进行异常粪便测试的随访。我们将 通过定量和 定性措施。实施研究的结果将为该计划的规模提供信息 通过与20个为农村/边界初级保健服务的区域和国家组织建立合作伙伴关系 使用网络研讨会，培训培训研讨会和合作学习活动的诊所使用Echo （社区医疗保健结果的扩展）模型。