Optimizing Colorectal Cancer Screening PREcision and Outcomes in CommunIty-baSEd Populations (PRECISE)

优化社区人群的结直肠癌筛查精度和结果 (PRECISE)

• 批准号: 9906181
• 负责人: DOUGLAS Allen CORLEY
• 金额: $ 314.98万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-15 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906181
• 关键词: Address; Adherence; Adult; African American; Age; Area; Asian Americans; Behavioral Sciences; Cancer Center; Cancer Etiology; Cessation of life; Clinical Trials; Collaborations; Colonoscopy; Colorectal; Colorectal Cancer; Communities; Conflict (Psychology); Consultations; Data; Data Collection; Data Element; Data Pooling; Data Set; Deductibles; Detection; Diagnosis; Early Diagnosis; Effectiveness; Evaluation; Excision; Failure; Fee-for-Service Plans; Geography; Goals; Guidelines; Health system; Healthcare; Hispanics; Impairment; Incentives; Incidence; Insurance; Intervention; Leadership; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Malignant neoplasm of lung; Manuscripts; Measures; Medicare/Medicaid; Meta-Analysis; Methods; Modality; Modeling; Morbidity - disease rate; NCI Center for Cancer Research; Observational Study; Organ; Outcome; Patients; Pattern; Persons; Physicians; Polypectomy; Polyps; Population; Precancerous Polyp; Process; Provider; Publications; Publishing; Recommendation; Research; Resources; Risk; Risk Estimate; Scientist; Screening for cancer; Surveys; System; Testing; United States; Variant; adenoma; aged; barrier to care; base; cancer diagnosis; colon cancer patients; colorectal cancer risk; colorectal cancer screening; demographics; design; disparity reduction; effective intervention; effectiveness testing; follow-up; high risk; human very old age (85+); improved; mortality; mortality disparity; older patient; personalized screening; population based; preventable death; public health relevance; safety net; screening; screening guidelines; sex; symposium; theories; validation studies; Address; Adherence; Adult; African American; Age; Area; Asian Americans; Behavioral Sciences; Cancer Center; Cancer Etiology; Cessation of life; Clinical Trials; Collaborations; Colonoscopy; Colorectal; Colorectal Cancer; Communities; Conflict (Psychology); Consultations; Data; Data Collection; Data Element; Data Pooling; Data Set; Deductibles; Detection; Diagnosis; Early Diagnosis; Effectiveness; Evaluation; Excision; Failure; Fee-for-Service Plans; Geography; Goals; Guidelines; Health system; Healthcare; Hispanics; Impairment; Incentives; Incidence; Insurance; Intervention; Leadership; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Malignant neoplasm of lung; Manuscripts; Measures; Medicare/Medicaid; Meta-Analysis; Methods; Modality; Modeling; Morbidity - disease rate; NCI Center for Cancer Research; Observational Study; Organ; Outcome; Patients; Pattern; Persons; Physicians; Polypectomy; Polyps; Population; Precancerous Polyp; Process; Provider; Publications; Publishing; Recommendation; Research; Resources; Risk; Risk Estimate; Scientist; Screening for cancer; Surveys; System; Testing; United States; Variant; adenoma; aged; barrier to care; base; cancer diagnosis; colon cancer patients; colorectal cancer risk; colorectal cancer screening; demographics; design; disparity reduction; effective intervention; effectiveness testing; follow-up; high risk; human very old age (85+); improved; mortality; mortality disparity; older patient; personalized screening; population based; preventable death; public health relevance; safety net; screening; screening guidelines; sex; symposium; theories; validation studies

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Most deaths are preventable through early detection, but failures of screening completion and quality substantially impair test effectiveness. This proposal unites the productive PROSPR I CRC Centers into a single collaboration to address key questions and pilot interventions to improve CRC screening outcomes. In PROSPR I, we developed a strong transdisciplinary, multisite collaboration. We collected 316 data elements, performed validation studies, created high-quality pooled data sets to identify patient, provider, and system gaps in the CRC screening process factors and published >60 manuscripts. Our unified PROSPR II Research Center (PRC) will use these proven collaborations and >10 years of longitudinal data for >8.9 million screen-eligible people (~ 1 of 40 eligible people in the US), large numbers of screening exposures (>8.4 million fecal immunochemical tests [FIT] and >1.9 million colonoscopies), and outcomes (>28,000 CRCs). Our PRC is geographically, demographically and economically diverse (three states, >800,000 African Americans, 1.6 million Hispanics, and 1 million Asian Americans). The health systems have different CRC screening patterns, different modalities, and include all major insurance/reimbursement methods (safety net, Medicare, Medicaid, high-deductible and pre-paid/fee-for-service, staff-model and incentivized providers). Our PROSPR I research identified major deficiencies in three areas of CRC screening: who should get screening and surveillance and when; why people do not complete recommended screening, surveillance or follow-up of positive tests; and how test quality and accuracy can be improved. Project 1 will identify on whom and when screening should be performed, particularly for those with conflicting recommendations (e.g., African Americans aged 40-49 years, and patients 76-85 years old). Project 2 will evaluate when surveillance should occur after a precancerous polyp diagnosis, using baseline colonoscopy results and precise new 10-year risk estimates for CRC. Project 3 will explore long-term screening patterns and multilevel drivers of why screening and surveillance are not appropriately completed, especially in understudied patients who never screen, fail to re-screen, use surveillance inappropriately or fail to follow up after a positive screening test. Project 4 will evaluate how to increase the effectiveness of FIT and colonoscopy by optimizing age- and sex-stratified quantitative FIT abnormal ranges, establishing precise adenoma detection thresholds for quality improvement and evaluating drivers of adenoma detection. We will use results from these observational studies, behavioral science methods, and stakeholder involvement to develop and pilot test multilevel interventions. Our transdisciplinary team of scientists, physicians, and healthcare experts will also provide leadership and data for trans-PROSPR, multiple-organ collaborations. The proposed research can substantially decrease the burden of CRC by reducing disparities and identifying ways to improve screening completion and effectiveness.

结直肠癌（CRC）是美国癌症死亡的第二大原因。大多数死亡是 可以通过早期检测来预防，但筛选完成和质量的失败大大损害了测试 效力。该提案将生产性的ProSPR I核心融合到一次合作中 解决关键问题和试点干预措施，以改善CRC筛查结果。在prospr i中，我们 建立了强大的跨学科的多站点合作。我们收集了316个数据元素，执行 验证研究创建了高质量的合并数据集，以识别患者，提供者和系统差距 CRC筛选过程因素和> 60个手稿。我们统一的ProSPR II研究中心 （PRC）将使用这些经过验证的合作和> 10年的纵向数据，> 890万个符合屏幕的资格 人（美国40名合格人物中的1个），大量的筛查暴露（> 840万个粪便 免疫化学测试[FIT]和> 190万个结肠镜检查）和结果（> 28,000 CRC）。我们的中国是 地理，人口统计学和经济上多样化（三个州，> 80万非裔美国人，1.6 百万西班牙裔和100万亚裔美国人）。卫生系统具有不同的CRC筛查模式， 不同的方式，包括所有主要保险/报销方法（安全网，医疗保险，医疗补助， 高扣除和预付费/收费服务，员工模型和激励提供者）。 我们的ProSPR I研究确定了CRC筛查三个领域的主要缺陷：谁应该得到 筛查和监视以及何时；为什么人们不完成建议筛选，监视或 阳性测试的随访；以及如何提高测试质量和准确性。项目1将确定谁 当应该进行筛查时，特别是对于那些有冲突的人（例如，非洲人） 40-49岁的美国人，患者76-85岁）。项目2将评估监视应何时应 在癌前息肉诊断后发生，使用基线结肠镜检查结果和精确的10年风险 CRC的估计。项目3将探讨为什么筛选的长期筛选模式和多层次驱动力 并且监视尚未适当地完成，尤其是在从未筛查的经过研究的研究的患者中 重新屏幕，使用阳性筛查测试后，使用监视不适当或无法跟进。项目4 Will 评估如何通过优化年龄和性别分层来提高拟合和结肠镜检查的有效性 定量拟合异常范围，建立精确的腺瘤检测阈值以提高质量 并评估腺瘤检测的驱动因素。我们将使用这些观察性研究的结果，行为 科学方法以及利益相关者参与开发和试点测试多层次干预措施。我们的 科学家，医师和医疗保健专家的跨学科团队还将为 跨性别，多器官合作。拟议的研究可以大大减轻负担 通过降低差异并确定改善筛查完成和有效性的方法来实现CRC。