Klabunde Carrie N, Lanier David, Breslau Erica S, Zapka Jane G, Fletcher Robert H, Ransohoff David F, Winawer Sidney J
Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, EPN 4005, 6130 Executive Boulevard, Bethesda, MD 20892-7344, USA.
J Gen Intern Med. 2007 Aug;22(8):1195-205. doi: 10.1007/s11606-007-0231-3. Epub 2007 May 30.
Colorectal cancer (CRC) screening has been supported by strong research evidence and recommended in clinical practice guidelines for more than a decade. Yet screening rates in the United States remain low, especially relative to other preventable diseases such as breast and cervical cancer. To understand the reasons, the National Cancer Institute and Agency for Healthcare Research and Quality sponsored a review of CRC screening implementation in primary care and a program of research funded by these organizations. The evidence base for improving CRC screening supports the value of a New Model of Primary Care Delivery: 1. a team approach, in which responsibility for screening tasks is shared among other members of the practice, would help address physicians' lack of time for preventive care; 2. information systems can identify eligible patients and remind them when screening is due; 3. involving patients in decisions about their own care may enhance screening participation; 4. monitoring practice performance, supported by information systems, can help target patients at increased risk because of family history or social disadvantage; 5. reimbursement for services outside the traditional provider-patient encounter, such as telephone and e-mail contacts, may foster enhanced screening delivery; 6. training opportunities in communication, cultural competence, and use of information technologies would improve provider competence in core elements of screening programs. Improvement in CRC screening rates largely depends on the efforts of primary care practices to implement effective systems and procedures for screening delivery. Active engagement and support of practices are essential for the enormous potential of CRC screening to be realized.
结直肠癌（CRC）筛查已获得强有力的研究证据支持，并在临床实践指南中被推荐了十多年。然而，美国的筛查率仍然很低，尤其是相对于乳腺癌和宫颈癌等其他可预防疾病而言。为了探究原因，美国国立癌症研究所和医疗保健研究与质量局发起了一项针对初级保健中CRC筛查实施情况的审查，以及由这些组织资助的一项研究计划。改善CRC筛查的证据基础支持一种新型初级保健服务模式的价值：1. 团队协作方法，即由诊所的其他成员分担筛查任务的责任，这将有助于解决医生缺乏预防保健时间的问题；2. 信息系统可以识别符合条件的患者，并在筛查到期时提醒他们；3. 让患者参与自身护理决策可能会提高筛查参与度；4. 在信息系统的支持下监测诊所的表现，有助于针对因家族病史或社会劣势而风险增加的患者；5. 为传统医患诊疗之外的服务（如电话和电子邮件联系）提供报销，可能会促进筛查服务的改善；6. 提供沟通、文化能力和信息技术使用方面的培训机会，将提高医疗服务提供者在筛查项目核心要素方面的能力。CRC筛查率的提高很大程度上取决于初级保健诊所实施有效筛查系统和程序的努力。诊所的积极参与和支持对于实现CRC筛查的巨大潜力至关重要。
