Primary Care Colorectal Cancer Screening Surveillance

初级保健结直肠癌筛查监测

• 批准号: 6768214
• 负责人: Richard Michael Hoffman
• 金额: $ 16.88万
• 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/6768214
• 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） 结直肠癌是美国的一个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，但流行病学数据显示结直肠癌病例和死亡人数始终很高。此外，很大一部分病例在确诊时已处于晚期，此时治疗的效果要差得多。这些发现表明结直肠癌筛查的实施和利用存在问题。筛查工作以初级保健机构为基础，我们建议实施电子初级保健结直肠癌筛查监测系统，涉及新墨西哥退伍军人管理局 (VA) 医疗保健系统、新墨西哥大学医学院和洛夫莱斯桑迪亚卫生系统。这些组织是新墨西哥州的三个主要医疗保健提供者，为地理和种族多样化的人群提供服务。 我们将使用该信息系统通过描述新墨西哥州初级保健实践中结直肠癌筛查的实施、利用、效率和结果来实现 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电子医疗记录中收集结直肠癌筛查和结果数据，这些数据涵盖三个卫生系统的初级保健诊所及其相关的胃肠病学诊所和病理学实验室。将收集有关患者（人口统计、临床病史）和医疗保健系统（地理位置、诊所类型、提供者类型、筛查计划）特征的具体数据；提供结直肠癌筛查测试，包括粪便潜血测试、内窥镜检查和放射学检查；患者对这些筛查服务的利用；从订购/提供筛查和诊断测试到测试完成/开始治疗的时间间隔；筛查和诊断测试的结果，包括病理结果和初始癌症治疗；以及各种结直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州肿瘤登记处（全州流行病学监测和最终结果 (SEER) 登记处）相关联，以识别流行和偶发的结直肠癌病例，使我们能够评估筛查率和癌症结果。将进行适当的统计测试来实现研究目标，包括受试者描述、筛查测试率、当前筛查的患者比例、完成筛查/诊断测试和开始治疗的中位时间，以及与相关的患者和医疗保健系统因素这些结果。我们还将评估结直肠癌筛查测试的诊断性能，包括阳性预测值和产量。 除了实现 PAR 的目标外，建立初级保健结直肠癌筛查监测系统还将使我们能够跟踪未来筛查干预措施在初级保健实践中的扩散，并评估旨在提高结直肠癌筛查率和死亡率的医疗保健系统变革的影响。结直肠癌筛查的效率。