Primary Care Colorectal Ca Screening Surveillance System

初级保健结直肠钙筛查监测系统

• 批准号: 6880136
• 负责人: Richard Michael Hoffman
• 金额: $ 15.86万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-04-01 至 2006-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6880136
• 关键词: cancer registry /resource; clinical research; colorectal neoplasms; diagnosis design /evaluation; disease /therapy duration; endoscopy; gastrointestinal imaging /visualization; geographic site; health care service evaluation; health care service utilization; health services research tag; human data; human subject; mass screening; medical records; neoplasm /cancer diagnosis; outcomes research; patient care management; statistics /biometry

DESCRIPTION (provided by applicant) Colorectal cancer is an important public health problem in the United States. Despite studies showing that screening can reduce the incidence and mortality of this cancer, epidemiologic data show consistently high numbers of colorectal cancer cases and deaths. Furthermore, a high proportion of cases are being diagnosed at an advanced stage, when treatment is far less effective. These findings suggest that there are problems in the delivery and utilization of colorectal cancer screening. Screening efforts are based in primary care settings and we propose to implement an electronic primary care colorectal cancer screening surveillance system involving the New Mexico Veterans Administration (VA) Health Care System, the University of New Mexico School of Medicine, and the Lovelace Sandia Health System. These organizations are three of the major health care providers in the state of New Mexico, and serve very geographically and ethnically diverse populations. We will use this information system to address objectives of PAR-02-042, Colorectal Cancer in Primary Care Practice, by describing colorectal cancer screening delivery, utilization, efficiency, and outcomes in primary care practices in New Mexico. We will collect colorectal cancer screening and outcome data from electronic clinical and billing files and electronic medical records encompassing the primary care clinics in the three health systems and their associated gastroenterology clinics and pathology labs. Specific data will be collected on patient (demographic, clinical history) and health care system (geographic site, clinic type, provider type, screening programs) characteristics; delivery of colorectal cancer screening tests, including fecal occult blood testing, endoscopic procedures, and radiolologic procedures; patient utilization of these screening services; time intervals from ordering/providing screening and diagnostic tests to test completion/treatment initiation; results of screening and diagnostic testing, including pathologic findings and initial cancer treatment; and the diagnostic performance characteristics of the various colorectal cancer screening tests. These clinical data will be linked to the New Mexico Tumor Registry, a statewide Surveillance Epidemiology and End Results (SEER) registry, to identify prevalent and incident colorectal cancer cases, enabling us to assess screening rates and cancer outcomes. Appropriate statistical tests will be performed to address the study aims, including descriptions of subjects, screening testing rates, proportion of patients currently screened, median time to completion of screening/diagnostic testing and initiating treatment, and the patient and health care system factors associated with these outcomes. We will also evaluate the diagnostic performance of colorectal cancer screening tests, including positive predictive value and yield. In addition to addressing the objectives of the PAR, establishing a primary care colorectal cancer screening surveillance system will also enable us to track the diffusion of future screening interventions into primary care practice and evaluate the effects of health care system changes designed to increase the rate and efficiency of colorectal cancer screening.

描述（由申请人提供）结直肠癌是美国重要的公共卫生问题。尽管研究表明筛查可以降低这种癌症的发病率和死亡率，但流行病学数据表明，大量的结直肠癌病例和死亡人数始终如一。此外，当治疗效率远不足时，在高级阶段诊断出很大比例的病例。这些发现表明，结直肠癌筛查的分娩和利用存在问题。筛查工作基于初级保健环境，我们建议实施涉及新墨西哥州退伍军人管理局（VA）卫生保健系统，新墨西哥大学医学院和Lovelace Sandia Health System的电子初级保健癌症筛查监视系统。这些组织是新墨西哥州的三个主要医疗保健提供者，并在地理和种族上非常多样化。 我们将使用此信息系统来解决新墨西哥州初级保健实践中的大肠癌筛查，利用率，效率和结果，以解决PAR-02-042，初级保健实践中的结直肠癌的目标。我们将从电子临床和计费文件以及涵盖三个卫生系统及其相关胃肠病学诊所和病理学实验室的初级保健诊所的电子病历以及电子病历中收集结直肠癌筛查和结果数据。将收集有关患者（人口统计学，临床病史）和医疗保健系统（地理地理地点，诊所类型，提供者类型，筛查计划）特征的具体数据；分娩结直肠癌筛查测试，包括粪便隐匿血液测试，内窥镜手术和放射性程序；患者利用这些筛查服务；从订购/提供筛查和诊断测试的时间间隔到测试完成/治疗开始；筛查和诊断测试的结果，包括病理发现和初始癌症治疗；以及各种大肠癌筛查测试的诊断性能特征。这些临床数据将与新墨西哥肿瘤注册中心（全州监视流行病学和最终结果（SEER）注册中心（SEER）注册中心有关，以识别流行和入射的结直肠癌病例，使我们能够评估筛查率和癌症结果。将进行适当的统计检验以解决研究目标，包括对受试者的描述，筛查测试率，当前筛查的患者比例，中位数时间完成筛查/诊断测试和启动治疗以及与这些结果相关的患者和卫生保健系统因素。我们还将评估结直肠癌筛查测试的诊断性能，包括积极的预测价值和产量。 除了解决PAR的目标之外，建立初级保健结直肠癌筛查监视系统还将使我们能够跟踪未来的筛查干预措施扩散到初级保健实践中，并评估旨在提高色直癌筛查率和效率的医疗保健系统变化的影响。