Addressing Disparities in Outcomes of Screening for Colorectal Cancer in Community-Based Settings

解决社区环境中结直肠癌筛查结果的差异

基本信息

批准号：
10682099
负责人：
DOUGLAS Allen CORLEY
金额：
$ 70.04万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-05-04 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10682099
关键词：
Address Age Attention Biological Black American Black Populations Black race California Cancer Etiology Cause of Death Cessation of life Characteristics Clinical Practice Guideline Collaborations Colon Colonoscopy Colorectal Cancer Communities Data Data Element Death Rate Detection Diagnosis Diagnostic Disadvantaged Disease Outcome Disparity Early Diagnosis Education Ethnic Origin Ethnic Population Evaluation Foundations Goals Guidelines Health Improve Access Incidence Indigenous Information Systems Intervention Interview Intestines Location Longitudinal trends Malignant Neoplasms Medicare/Medicaid Methods Modeling Native Americans Operative Surgical Procedures Outcome Patients Pattern Persons Phase Population Positioning Attribute Preparation Prevention Process Productivity Race Reporting Research SEER Program Screening Result Standardization Survival Rate Testing Treatment outcome United States United States Preventative Services Task Force Variant Woman Work adenoma attributable mortality cancer health disparity cohort colorectal cancer risk colorectal cancer screening disparity elimination ethnic minority ethnic minority population experience follow-up health equity human very old age (85+)implementation evaluation implementation strategy innovation member men models and simulation mortality mortality disparity multidisciplinary older men older women public health priorities racial disparity racial minority racial minority population racial population screening screening program sex social social disparities social factors social group sociodemographics success therapy design

项目摘要

PROJECT SUMMARY/ABSTRACT: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States and although the overall CRC mortality rate has been decreasing, disparities have persisted, particularly for Black and Native American people. CRC screening is highly effective and there is a welcome national attention on improving access to screening for groups that are socially disadvantaged. However, the benefits of screening depend on receiving both high-quality testing and timely follow-up care when abnormal. Thus, disparities may persist even when rates of participation in screening are similar across populations. Recently, the US Preventive Services Task Force highlighted a gap in the understanding of CRC disparities and the relative lack of interventions that have been shown to eliminate disparities by race and ethnicity. The goal of this application is to inform feasible and effective strategies for advancing health equity by elucidating the extent to which differences in care along the entire screening process cumulatively contribute to disparities. We will comprehensively evaluate the entire screening continuum from the tests used and screening quality to receipt of follow-up care and guideline-concordant treatment in a cohort of about 3.8 million people per year over a nearly 2-decade period in Kaiser Permanente Northern California (KPNC) and Kaiser Permanente Southern California (KPSC). We will use a mixed methods approach informed by health equity frameworks to examine: 1) the receipt and quality of screening for CRC, including follow-up when abnormal; 2) post-screening treatment and disease outcomes, including interval CRCs, 5-year survival, and age-standardized incidence and mortality, overall and by location; 3) the reasons for variations in quality and timely follow-up using qualitative interviews; and 4) the relative contributions of differences along the screening continuum to disparities in mortality by using microsimulation modeling. We will conduct our studies in a dynamic cohort of 45-85-year-old men and women in KPNC/KPSC during the 2003-2019 period. The members of KPNC and KPSC mirror the characteristics, in terms of social factors, of people in the regions served across California. The complete capture of all screening steps and diverse, well-defined populations enable studies of strategies across the screening continuum among social groups. Our analyses will compare the racial and ethnic groups and stratifications by race for each outcome over a nearly 2-decade period. We will interview patient-clinician dyads to elucidate reasons for variations in quality, follow-up, and outcome. We will also use the MISCAN-Colon microsimulation model to examine the extent to which disparities in mortality are attributable to differences found across each step in the screening continuum. The proposed research has a high potential to inform the prioritization of strategies for advancing health equity across disadvantaged racial and ethnic minority groups and thus advance a national public health priority. The 1½ decades of high-impact collaboration in our team, and the setting and rigor of our application support the feasibility and high potential for impact in the field.

项目摘要/摘要：大肠癌（CRC）是癌症死亡的第二大原因美国，尽管总体CRC死亡率一直在降低，但差异仍然存在，但特别是美国黑人和美国原住民。 CRC筛查非常有效，欢迎全国对改善社会困扰团体筛查的访问的关注。但是，筛查的好处取决于在异常时同时接受高质量的测试和及时的随访护理。这样，即使在人群之间进行筛查率相似，差异也可能会持续。最近，美国预防服务工作组强调了了解CRC分布和相对缺乏干预措施，这些干预措施通过种族和种族消除了差距。目标此应用程序是为了阐明可行有效的策略来提高健康公平的策略整个筛查过程中护理差异的范围累积造成了差异。我们将全面评估所使用的测试和筛选质量的整个筛选连续性每年约有380万人接受后续护理和指导方案治疗在Kaiser Permanente北加州（KPNC）和Kaiser Permanente的近2个十年期间南加州（KPSC）。我们将使用健康公平框架告知的混合方法方法检查：1）CRC的筛选收据和质量，包括异常时的随访； 2）筛选后治疗和疾病结果，包括间隔CRC，5年生存以及年龄标准化的事件和死亡率，整体和位置； 3）使用定性的质量变化和及时随访的原因访谈； 4）筛选连续体差异对差异的相对贡献使用微仿真模型来死亡。我们将以45-85岁的动态队列进行研究在2003 - 2019年期间，KPNC/KPSC的男性和女人。 KPNC和KPSC的成员反映了在加利福尼亚州服务的地区的社会因素方面的特征。完整捕获所有筛查步骤和潜水员定义明确的人群，可以研究整个策略在社会群体之间进行筛查。我们的分析将比较种族和族裔群体，以及在近2个十年的时间内，每场结果的分层分层。我们将采访患者 - 阵容二元组阐明质量，随访和结果差异的原因。我们还将使用灾难微观仿真模型以检查死亡率分布的程度可归因于发现的差异整个筛选连续体的每个步骤。拟议的研究具有很高的潜力来告知优先考虑在受灾的种族和少数民族群体中推进健康平等的策略从而提高了国家公共卫生的优先事项。我们团队中的1½十年的高影响力合作，我们应用程序的设置和严格支持可行性和高潜力在该领域的影响。