Implementing evidence based colorectal cancer screening in rural clinics

在农村诊所实施循证结直肠癌筛查

• 批准号: 10567653
• 负责人: Victoria Lee Champion
• 金额: $ 66.35万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10567653
• 关键词: Adoption; Affect; Cancer Etiology; Cancer Intervention; Cessation of life; Clinic; Clinical; Colonoscopy; Colorectal Cancer; Data; Diagnostic; Dose; Effectiveness; Evidence based intervention; Goals; Guidelines; Health Services; Immunologic Tests; Incidence; Indiana; Individual; Intervention; Interview; Knowledge; Maintenance; Measures; Modeling; Outcome; Patients; Persons; Physicians; Policies; Preparation; Promoting Action on Research Implementation in Health Services framework; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recommendation; Resolution; Risk; Rural; Rural Health; Specialist; Test Result; Testing; Variant; budget impact; colorectal cancer screening; contextual factors; cost; cost effective; cost estimate; cost outcomes; cost-effectiveness evaluation; educational atmosphere; effectiveness evaluation; effectiveness outcome; evidence base; experience; falls; future implementation; implementation evaluation; implementation facilitation; implementation outcomes; implementation process; implementation strategy; improved; innovation; mortality; patient navigation; primary care practice; response; rural area; rural health clinic; rural setting; screening; treatment as usual; uptake

Project Summary/Abstract Colorectal cancer (CRC) remains the third most common cause of cancer mortality in the US with 53,200 deaths expected in 2021, even though this number could be greatly reduced through appropriate screening.1 Compared to their urban counterparts, individuals living in rural areas experience a 50% higher incidence of CRC (OR 1.50, CI:1.43-1.57) and 35% higher mortality (OR 1.35,CI: 1.26-1.45), with rural segments of the US falling far below the National Colorectal Cancer Roundtable CRC screening goal of 80%.2-4-5 Equally poor results are found for the resolution of a positive fecal immunological test (FIT) result, which occurs in 8% of all patients initially tested with FIT. Only 50 to 55% of individuals with positive FIT results follow through with a diagnostic colonoscopy.7-11 One of the most effective approaches to increasing CRC screening is an evidence-based intervention (EBI) combining a mailed (FIT) and patient navigation (PN).12 Unfortunately, implementation of this EBI in rural settings is limited. Thus, in response to the call to identify strategies for overcoming barriers to the adoption of evidence-based interventions (PAR-19-274), we will evaluate the effectiveness of bundled facilitation implementation strategies to increase uptake of EBI’s for CRC screening. Our aims support the modeling necessary to guide future implementation of the EBI for CRC screening in rural clinics. In Aim 1, we will evaluate the ability of an implementation of an EBI to improve CRC screening and diagnostic colonoscopy rates, defined as completed screening episode (effectiveness) through implementation of an EBI for CRC screening in rural Indiana. We hypothesize that a complete screening episode of CRC screening (FIT or screening colonoscopy), including diagnostic colonoscopy uptake following positive FIT, will be higher following implementation of an EBI and throughout maintenance compared to baseline (usual care). Resolution with diagnostic colonoscopy and repeat screening with FIT will be handled as exploratory outcomes. In Aim 2 we will evaluate the variation in contextual factors (innovation, recipient, inner and outer context), implementation strategies and implementation outcomes (reach and implementation) using mixed data (qualitative interviews and quantitative measures) to build implementation profiles of nine rural clinics. In Aim 3, we estimate the cost and budget impact of the deployment of implementation strategies and processes for rural clinics and evaluate the cost-effectiveness of implementing and sustaining the CRC screening intervention.

项目摘要/摘要 结直肠癌（CRC）仍然是美国癌症死亡率的第三大最常见原因，有53,200 即使通过适当的筛查可以大大降低这一数字，预计将在2021年进行死亡。1 与城市同行相比，居住在农村地区的人的事件增加了50％ CRC（OR 1.50，CI：1.43-1.57），死亡率提高35％（OR 1.35，CI：1.26-1.45），美国的粗糙段 远低于国家大肠癌圆桌会议CRC筛查目标80％.2-4-5同样差 发现解决阳性粪便免疫测试（fit）结果的结果，该结果发生在所有的8％。 患者最初对拟合进行了测试。只有50％至55％的具有正拟合结果的个体遵循 诊断结肠镜检查7-11 增加CRC筛查的最有效方法之一是基于证据的干预措施（EBI） 结合了邮寄（拟合）和患者导航（PN）。12不幸的是，该EBI在粗糙中实施 设置有限。这是回应呼吁确定克服采用障碍的策略的呼吁 基于证据的干预措施（PAR-19-274），我们将评估捆绑设施的有效性 实施策略，以增加对CRC筛查的EBI吸收。我们的目标支持建模 指导未来在农村诊所进行CRC筛查的EBI实施所需的必要条件。 在AIM 1中，我们将评估EBI实施改善CRC筛查和诊断的能力 结肠镜检查率定义为通过实施EBI的完成筛查发作（有效性） 用于在Rough Indiana进行CRC筛查。我们假设CRC筛选的完整筛选（fit） 或筛查结肠镜检查），包括阳性拟合后的诊断结肠镜检查，将更高 在实施EBI和整个维护之后，与基线相比（通常的护理）。 通过诊断结肠镜检查和拟合重复筛查的分辨率将作为探索性处理 结果。在AIM 2中，我们将评估上下文因素（创新，收件人，内部和外部）的变化 上下文），使用混合 数据（定性访谈和定量措施），以建立九个粗糙诊所的实施概况。 在AIM 3中，我们估算了实施策略部署的成本和预算影响以及 粗糙诊所的流程，并评估实施和维持CRC的成本效益 筛查干预措施。