(ACCSIS) Accelerating Colorectal Cancer Screening through Implementation Science in Appalachia

(ACCSIS) 通过阿巴拉契亚地区的科学实施加速结直肠癌筛查

• 批准号: 10471942
• 负责人: MARK B DIGNAN
• 金额: $ 115.54万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10471942
• 关键词: Address; Administrator; Advisory Committees; Age; Appalachian Region; Area; Area Health Education Centers; Behavior assessment; Behavioral Risk Factor Surveillance System; Cancer Control; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinic; Clinical; Collaborations; Colorectal Cancer; Communication; Communities; Community Health; Community Health Systems; Community Outreach; County; Data Collection; Digit structure; Disease; Electronic Health Record; Evidence based intervention; Fright; Geography; Goals; Guidelines; Health; Health Care Costs; Health Personnel; Incidence; Intervention; Intervention Studies; Intervention Trial; Kentucky; Knowledge; Life; Link; Localized Malignant Neoplasm; Low Income Population; Measures; National Cancer Institute; Neighborhood Health Center; Ohio; Outcome; Patients; Phase; Play; Population; Poverty; Preventive care; Preventive service; Provider; Public Health; Randomized; Recording of previous events; Research; Research Personnel; Research Project Grants; Role; Rural; Rural Appalachia; Rural Community; Savings; Site; Source; Surveys; System; Telephone; Testing; Trust; Underserved Population; United States; Universities; Work; base; behavioral outcome; cancer education; cancer health disparity; cancer prevention; colorectal cancer screening; community clinic; community organizations; community-level factor; effective intervention; evidence base; experience; follow-up; health care availability; health care delivery; implementation science; improved; interest; medically underserved; medically underserved population; mortality; pilot test; randomized trial; safety net; scale up; screening; underserved area; uptake

Modified Project Summary/Abstract Section This multi-site project aims to increase screening and follow-up for colorectal cancer (CRC) in central Appalachia, a medically underserved region recognized as one of three distinct “hotspots” for CRC mortality. Specifically, the Appalachian Regional Commission classifies 32 eastern Ohio (OH) counties and the 54 counties in eastern Kentucky (KY) as north central and central Appalachia, respectively. CRC incidence and mortality rates in the area are among the highest in the nation, and neither state meets the national target of 80% of eligible residents screened for CRC. There have been few randomized intervention trials addressing multiple levels of influence on CRC screening behaviors and outcomes in this region. To address this gap, investigators at the University of Kentucky and The Ohio State University will build on a 12-year collaborative history, strong relationships with Appalachian communities and health clinics, and extensive experience with community-based cancer prevention and control intervention research to develop, implement, and evaluate a multilevel intervention (MLI) – adapted from evidence-based interventions that include components targeting clinics and providers (in-reach) and the community (outreach) – to increase CRC screening, follow-up and referral-to-care among patients age 50-74 in 12 counties in Appalachian KY and OH. The overall goals of this project are to contribute to the evidence-base for a MLI that increases rates of CRC screening, follow-up, and referral-to-care, particularly in rural, medically underserved populations, and help showcase best practices for how MLIs can be scaled-up to reduce the burden of CRC in the U.S. For the Planning-Exploratory Phase (UG3) in Year 1, our specific aims are to: 1) Pilot test, measure, and refine a MLI to increase rates of CRC screening, follow-up and referral-to-care in Appalachian OH and Appalachian KY; and 2) Provide evidence supporting transition to the Implementation Phase (UH3) [per NCI approval]. For the Implementation Phase (UH4) in Years 2-5, our specific aims are to: 1) Test the revised MLI in a group randomized trial, delayed intervention to assess the impact of the MLI on increasing rates of CRC screening, follow-up, and referral-to-care among Appalachian KY and Appalachian OH populations; and 2) Assess dissemination and sustainability of the intervention. The project will be implemented in collaboration with community and clinical partners in 12 counties, 6 in Ohio and 6 in Kentucky. Counties will be randomized to early or delayed intervention after baseline data collection. The main outcome will be CRC screening as defined by US Preventive Services Task Force guidelines and measured by clinic electronic health records and county- level behavioral assessments using random digit dialed telephone surveys similar to CDC’s Behavioral Risk Factor Surveillance System. Our work will be accomplished through collaboration with the ACCSIS Coordinating Center, other ACCSIS Research Projects, ACCSIS Steering Committee and Workgroups, NCI, and community partners. If effective, this MLI will be disseminated to our clinical and community partners throughout Appalachia.

修改的项目摘要/摘要部分 这个多站点的项目旨在增加阿巴拉契亚中部大肠癌（CRC）的筛查和随访，这是一个医学欠佳的地区，被公认为是CRC死亡率的三个不同的“热点”之一。具体而言，阿巴拉契亚地区委员会分别将32个俄亥俄州东部（OH）县和肯塔基州东部的54个县分别为阿巴拉契亚州中部和中部。该地区的CRC发病率和死亡率是美国最高的，并且两国都不符合80％的合格居民的国家目标。很少有随机干预试验解决该地区对CRC筛查行为和结果的多种影响。 To address this gap, investigators at the University of Kentucky and The Ohio State University will build on a 12-year collaborative history, strong relationships with Appalachian communities and health clinics, and extensive experience with community-based cancer prevention and control intervention research to develop, implement, and evaluate a multilevel intervention (MLI) – adapted from evidence-based interventions that include components targeting clinics and providers (in-reach) and the community (outreach) – to在阿巴拉契亚肯塔基州和OH的12个县中，增加了50-74岁患者的CRC筛查，随访和转诊至护理。该项目的总体目标是为MLI的证据碱做出贡献，该MLI增加了CRC筛查，随访和推荐率，尤其是在大致，医疗服务的大致，服务不足的人群中，并帮助展示如何扩大MLI的最佳实践，以减少美国CRC的燃烧，以减少CRC的燃烧，以减少计划验证阶段（我们的量子标准）（我们的一年级）。 MLI提高Appalachian OH和Appalachian KY的CRC筛查，随访和转诊至护理的比率； 2）提供了支持过渡到实施阶段（UH3）[NCI批准]的证据。对于2 - 5年的实施阶段（UH4），我们的具体目的是：1）在小组随机试验中测试修订后的MLI，延迟干预措施以评估MLI对CRC筛查，随访，随访，转介和Appalachian Ky和Appalachian OH种群中提高率的影响； 2）评估干预的传播和可持续性。该项目将与12个县的社区和临床合作伙伴合作实施，俄亥俄州6个，肯塔基州6个。基线数据收集后，县将被随机分配到早期或延迟干预措施。主要结果将是由美国预防服务工作组指南定义的CRC筛查，并通过临床电子健康记录和县级行为评估来衡量，使用随机数字拨号电话调查，类似于CDC的行为风险因素监视系统。我们的工作将通过与ACCSIS协调中心，其他ACCSIS研究项目，ACCSIS指导委员会和工作组，NCI和社区合作伙伴的合作来完成。如果有效，该MLI将通过阿巴拉契亚传播给我们的临床和社区合作伙伴。