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.

项目概要/摘要 结直肠癌 (CRC) 仍然是美国第三大癌症死亡原因，有 53,200 人死亡 预计 2021 年死亡人数，尽管通过适当的筛查可以大大减少这一数字。1 与城市邻居相比，生活在农村地区的人的患病率高出 50% 美国农村地区的 CRC（OR 1.50，CI：1.43-1.57）和死亡率高出 35%（OR 1.35，CI：1.26-1.45） 远远低于国家结直肠癌圆桌会议 CRC 筛查目标 80%。2-4-5 同样较差 粪便免疫学检测 (FIT) 阳性结果的解决结果，这种情况发生在 8% 的人中 最初接受 FIT 测试的患者中，只有 50% 至 55% 的患者会继续接受 FIT 测试。 诊断性结肠镜检查.7-11 增加 CRC 筛查最有效的方法之一是循证干预 (EBI) 将邮寄 (FIT) 和患者导航 (PN) 结合起来。12 不幸的是，在农村地区实施此 EBI 因此，为了响应号召，确定克服采用障碍的策略。 基于证据的干预措施 (PAR-19-274)，我们将评估捆绑式促进的有效性 提高 EBI 在 CRC 筛查中的采用率的实施策略 我们的目标支持建模。 有必要指导未来在农村诊所实施 EBI 进行 CRC 筛查。 在目标 1 中，我们将评估实施 EBI 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 完成的筛查事件（有效性） 我们勇敢地进行了一次完整的 CRC 筛查（FIT）。 或筛查结肠镜检查），包括阳性 FIT 后的诊断性结肠镜检查的采用率将会更高 与基线（常规护理）相比，实施 EBI 并进行全程维护后。 诊断性结肠镜检查的解决方案和 FIT 的重复筛查将被视为探索性处理 在目标 2 中，我们将评估背景因素（创新、接受者、内部和外部）的变化。 背景）、实施策略和实施结果（范围和实施）使用混合 数据（定性访谈和定量测量），以建立九个农村诊所的实施概况。 在目标 3 中，我们估计部署实施策略的成本和预算影响， 农村诊所的流程并评估实施和维持 CRC 的成本效益 筛查干预。