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： 这个两阶段项目旨在通过减轻负担来实现癌症登月目标 CRC 对美国人口的影响。具体来说，我们的目标是提高 CRC 筛查率、随访率 结肠镜检查，并通过实施直邮粪便检测将农村医疗补助患者转介至护理机构 具有针对性的外展和患者导航以进行后续结肠镜检查的计划。我们利用 与俄勒冈州农村实践研究网络 (ORPRN)、Kaiser Northwest 建立合作伙伴关系 健康研究中心和医疗补助健康计划并提供培训和实施 通过实践便利化来支持参与的农村初级保健诊所。总的来说，我们预计 与 30 个组织合作，促进 130 个初级保健诊所的实施 （覆盖 17,000 多名农村医疗补助患者）。 在第一阶段（第一年），我们将进行一个里程碑驱动的试点，为 大规模实施效果试验，包括调整诊所-健康计划-供应商 支持针对尚未建立护理和/或从未建立护理的农村医疗补助患者的直邮计划 已筛选；进行一项试点研究，测试患者导航的可行性和可接受性 支持粪便检查异常后的后续结肠镜检查；参与医疗补助健康计划和 在俄勒冈州农村和边境县招募 30 个初级保健诊所；并开发 在这些环境中实施大规模试验所需的培训和支持材料。 在第二阶段（第 02-05 年），我们将使用准 使用计划培训和实践在 30 个农村初级保健诊所进行实验性阶梯楔形设计 便利化支持实施。与试点项目一样，干预措施结合了：(1) 诊所健康计划- 供应商支持直邮粪便检测计划，有针对性地为从未接触过粪便的患者提供服务 已接受筛查或尚未建立护理的人员以及 (2) 为转诊人员提供的患者导航 结肠镜检查作为主要筛查或异常粪便检查的后续检查。我们将 通过定量和评估干预措施的有效性、实施和维持 定性措施。实施研究的结果将为该计划的扩大提供信息 通过与 20 个为农村/边境初级保健提供服务的区域和国家组织建立伙伴关系 使用 ECHO 进行网络研讨会、培训师培训研讨会和协作学习活动的诊所 （社区医疗保健成果的扩展）模型。