Martin Richard L, Tully Madelaine, Kos Allison, Frazer David, Williamson Amy, Conlon Amy, Enser James J, LoConte Noelle K
1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
2 Progressive Community Health Care Centers, Milwaukee, WI, USA.
Health Promot Pract. 2017 Sep;18(5):741-750. doi: 10.1177/1524839917705127.
Colorectal cancer is the second leading cause of cancer death in the United States. Black Americans suffer even higher incidence and death rates than the general population. Genetics and patient perceptions explain some of this difference, however, modifiable health care system factors such as lack of access to colon cancer screening also contribute. Partnering an academic health center with local community groups, we piloted a colorectal cancer screening program at a Federally Qualified Health Center (FQHC) serving predominately low socioeconomic status Black Americans. The program was designed to identify and remove barriers to screening and improve screening rates.
At a single center FQHC, we developed an outreach program centered around (1) patient and provider education, (2) immunochemical fecal occult blood test (iFOBT) distribution, and (3) patient navigation. We identified 402 eligible patients, of which 228 (56.7%) completed screening.
Our 56.7% screening rate represented a twofold increase above prepilot levels at the clinic. Nine (4%) iFOBT returned positive. Three of these nine patients completed colonoscopy. Screening rates and follow through were higher under a single navigator model.
Our academic-community partnership provided an effective, evidence based, and sustainable model for increasing colorectal cancer screening in a high risk, low resource community.
结直肠癌是美国癌症死亡的第二大主要原因。非裔美国人的发病率和死亡率甚至高于普通人群。遗传学和患者认知解释了部分这种差异，然而，一些可改变的医疗保健系统因素，如缺乏结肠癌筛查机会，也起到了作用。我们将一家学术健康中心与当地社区团体合作，在一家主要为社会经济地位较低的非裔美国人服务的联邦合格健康中心（FQHC）开展了一项结直肠癌筛查项目试点。该项目旨在识别并消除筛查障碍，提高筛查率。
在一家单一中心的FQHC，我们围绕（1）患者和医护人员教育、（2）免疫化学粪便潜血试验（iFOBT）分发以及（3）患者导航制定了一项外展项目。我们确定了402名符合条件的患者，其中228名（56.7%）完成了筛查。
我们56.7%的筛查率比该诊所试点前的水平提高了两倍。9份（4%）iFOBT检测呈阳性。这9名患者中有3名完成了结肠镜检查。在单一导航模式下，筛查率和后续跟进情况更高。
我们的学术 - 社区伙伴关系为在高风险、资源匮乏社区提高结直肠癌筛查率提供了一个有效、基于证据且可持续的模式。
