IMProving Adherence to Colonoscopy through Teams and Technology (IMPACTT)

通过团队和技术改进结肠镜检查的依从性 (IMPACTT)

基本信息

批准号：
10622548
负责人：
Urmimala Sarkar
金额：
$ 65.57万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-16 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10622548
关键词：
Address Adherence Adopted Attention Awareness Behavior COVID-19 pandemic California Caring Characteristics Chinese Clinic Clinical Services Colonoscopy Colorectal Cancer Communication Complement Consolidated Framework for Implementation Research Consultations Continuity of Patient Care Diagnostic Drug abuse Drug usage Early Diagnosis Electronic Health Record Evaluation Failure Feces Foundations Frontline worker Funding Gastroenterology HIV Infections Health Health Status Health behavior Health system Healthcare Healthcare Systems High Prevalence Home Impairment Incidence Infrastructure Instruction Integrated Health Care Systems Intervention Interview Intestines Language Low income Malignant Neoplasms Methods Minority Groups Outcome Patient Education Patients Population Heterogeneity Positioning Attribute Primary Care Process Provider Randomized Recording of previous events Reduce health disparities Reporting Research Resources Risk Sampling San Francisco Schedule Self Management Social support System Technology Test Result Testing Text Messaging Time Translating Vulnerable Populations Work cancer prevention care coordination colorectal cancer prevention colorectal cancer screening cost design disparity reduction ethnic minority population follow-up health information technology health literacy high risk housing instability implementation determinants implementation evaluation implementation framework implementation outcomes implementation research improved medical specialties mortality outreach patient level intervention patient navigation primary care clinic primary care provider programs racial minority population safety net screening

项目摘要

Project Summary Follow-up colonoscopy after abnormal stool-based colorectal cancer screening (e.g., fecal immunochemical test (FIT)) results in early detection of colorectal cancer (CRC), prevention of CRC, and reduction in CRC-mortality. FIT is a commonly utilized screening test that can be performed at home, is inexpensive, scalable, and often adopted in health systems where colonoscopy resources are scarce. Despite evidence that timely colonoscopy is necessary after an abnormal FIT result, completion colonoscopy occurs in less than 50% of patients at 6 months and varies significantly by clinic and health systems. In addition to understanding the meaning of an abnormal FIT, three care transitions must occur smoothly for the patient: colonoscopy referral, scheduling, and attendance. However, multilevel factors influence missed follow-up, and multilevel solutions are needed along the care continuum to address clinic-, provider-, and patient-level factors that impair or delay colonoscopy completion. IMProving Adherence to Colonoscopy through Teams and Technology (IMPACTT), proposes to close gaps and reduce disparities in CRC screening by improving completion of diagnostic colonoscopy following abnormal FIT in vulnerable populations using a multilevel approach consisting of interventions at the clinic-, provider- and patient-level. The specific aims are 1) to evaluate the effect of a clinic-level intervention targeting primary care providers and staff to adopt “best practices” to support colonoscopy completion in patients with abnormal FIT results, 2) to determine the effect of a patient-level technology intervention with enhanced instructions and navigation for patients with abnormal FIT to complete a diagnostic colonoscopy, and 3) to explore the multilevel implementation factors contributing to intervention outcomes using mixed methods. IMPACTT is situated in a publicly-funded, urban safety-net health system that cares for diverse, low-income patients with a high prevalence of limited health literacy and English proficiency. In order to develop solutions that work for vulnerable patients that are at particular risk to incomplete follow-up, interventions must be conducted in the settings that serve them. In addition, given the complexity of patient health behaviors and the multi-step process of colonoscopy completion, scalable interventions are needed. This proposal is feasible in this health system because 1) FIT screening is standard practice for CRC screening, 2) the system’s 12 primary care clinics is integrated with one gastroenterology practice, and 3) primary care and specialty care share an electronic health record and consultation system. These characteristics offer an infrastructure for implementation and evaluation, facilitated by effective care coordination and communication. IMPACTT is positioned to develop a multilevel intervention to improve CRC follow-up for vulnerable populations, which holds the potential to reduce health disparities in other health systems as well as lay the foundation to address other health conditions and behaviors.

项目摘要基于粪便基于粪便的结直肠癌筛查后的随访结肠镜检查（例如，粪便免疫化学测试（fit））导致早期检测结直肠癌（CRC），预防CRC和CRC年道形性的降低。 FIT是一种常用的筛选测试，可以在家中进行，便宜，可扩展，并且通常在稀缺的结肠镜检查资源的卫生系统中采用。尽管有证据表明结肠镜检查在拟合结果异常之后，有必要进行结肠镜检查，不到50％的患者在6例中发生几个月，诊所和卫生系统差异很大。除了了解一个异常拟合，必须顺利进行三个护理过渡：结肠镜检查，调度和出勤。但是，多层次因素会影响错过的随访，并且需要多级解决方案该护理继续解决损害或延迟结肠镜检查的诊所，提供者和患者水平的因素完成。通过团队和技术（ImpactT），缩小差距和通过改善异常拟合后的诊断结肠镜检查的完成来减少CRC筛查中的分布在弱势群体中，使用多层次方法，该方法包括诊所，提供商和患者级。具体目的是1）评估针对主要的临床水平干预的影响护理提供者和工作人员采用“最佳实践”来支持异常患者结肠镜检查适合结果，2）确定使用增强说明的患者级技术干预的影响以及适合诊断性结肠镜检查的异常患者的导航，3）探索使用混合方法导致干预结果的多级实施因素。 Impactt位于一个由公共资助的城市安全网卫生系统中，它关心潜水员，低收入患病率很高的患者健康素养和英语水平。为了开发解决方案这项工作是针对易受伤害的患者特别风险不完整的随访，干预措施必须是在为他们服务的设置中进行。此外，鉴于患者健康行为的复杂性和结肠镜检查的多步过程，需要可扩展的干预措施。该提议在该卫生系统是因为1）拟合筛选是CRC筛查的标准实践，2）该系统的12个主要护理诊所与一种胃肠病学实践融为一体，3）初级保健和专业护理共享电子健康记录和咨询系统。这些特征提供了实施的基础架构和评估，通过有效的护理协调和沟通准备。 Impactt有定位一项多层次干预措施，以改善弱势群体的CRC随访，这有可能减少其他卫生系统中的健康差异，并为解决其他健康状况的基础奠定了基础行为。