Reducing Disparities in Colorectal Cancer Screening through Proactive Outreach and Navigation in federally qualified health care centers in Brooklyn

通过在布鲁克林联邦合格的医疗保健中心进行主动外展和导航，减少结直肠癌筛查的差异

• 批准号: 10649941
• 负责人: Aasma Shaukat
• 金额: $ 50万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649941
• 关键词: Reducing; Disparities; Colorectal; Cancer; Screening

Colorectal Cancer (CRC) is the third most common cancer in men and women and the second leading cause of cancer related death. Screening for CRC reduces CRC incidence and mortality, and is recommended for average risk men and women between the ages of 45 and 75 by the US Preventive Services Task Force guidelines; which were updated recently to include 45-49 year olds, an additional 20 million individuals in the US. In New York City screening rates are 78% in Manhattan but only 26-55% in federally qualified Health Centers (FQHC) across the city that provide free and subsidized health services to underrepresented minorities. Currently, invitations to screen are offered only when a patient is seen by his or her provider. Consequently, many eligible individuals, particularly 45-55 year olds who do not regularly access healthcare, are under-screened. Hence, there is an unmet need for improving screening practices. We hypothesize that patient care (rates of CRC screening) will improve in under- served populations with the implementation of a proactive approach that incorporates a mailed outreach invitation to screen, followed by active assistance to a colonoscopy completion including overcoming financial and logistical barriers. To address this hypothesis, we seek to improve CRC screening in a hybrid type I trial by assessing the effectiveness and implementation of a proactive outreach colorectal cancer screening program in multiple federally qualified health centers (FQHCs) in Brooklyn, serving primarily Black patients. This proposed work will provide critical, foundational information for scaling up long-term, sustained implementation of screening program across other FQHCs in NYC. We propose to perform a randomized trial of proactive invitation at five FQHCs with aims to study the effect of a proactive outreach program that identifies those due for screening, mail a fecal immunochemical test and provide navigation and financial support for cost of preparation and transport to usual care in improving CRCc screening rates, understand barriers and facilitators to proactive outreach by surveying patients and providers, and perform a cost analysis of the program

结直肠癌 (CRC) 是男性和女性中第三大常见癌症，也是第二大常见癌症 癌症相关死亡的主要原因。 CRC 筛查可降低 CRC 发病率 死亡率，建议 45 岁至 75 岁之间的平均风险男性和女性使用 遵循美国预防服务工作组的指导方针；最近更新包括 45-49 岁的人群，在美国还有 2000 万人。纽约市的筛查率 78% 的人在曼哈顿，但只有 26-55% 在联邦合格的健康中心 (FQHC) 中 向代表性不足的少数群体提供免费和补贴医疗服务的城市。现在， 仅当患者的提供者看到患者时才会发出筛查邀请。 因此，许多符合资格的个人，特别是 45-55 岁的人，他们不定期 获得医疗保健，但未得到筛查。因此，改进筛查的需求尚未得到满足 做法。我们假设患者护理（结直肠癌筛查率）将在以下情况下得到改善： 通过实施积极主动的方法为民众提供服务，其中包括邮寄 外展邀请进行筛查，然后积极协助完成结肠镜检查 包括克服财务和后勤障碍。为了解决这个假设，我们寻求 通过评估有效性和改进混合 I 型试验中的 CRC 筛查 在多个联邦实施主动外展结直肠癌筛查计划 布鲁克林的合格医疗中心（FQHC）主要为黑人患者提供服务。这个提议 工作将为扩大长期、持续的 在纽约市其他 FQHC 中实施筛查计划。我们建议执行 在五个 FQHC 进行主动邀请的随机试验，旨在研究 积极主动的外展计划，确定那些需要筛查的人，邮寄粪便免疫化学物质 测试并为准备和运输费用提供导航和财务支持 关心提高 CRCc 筛查率，了解积极主动的障碍和促进因素 通过调查患者和提供者进行外展，并对计划进行成本分析