University of California Los Angeles, Los Angeles, California.
Department of Health Policy and Management, University of California, Los Angeles, 650 Charles Young Dr South, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900. E-mail:
Prev Chronic Dis. 2022 May 19;19:E26. doi: 10.5888/pcd19.210258.
Colorectal cancer screening rates remain suboptimal in the US. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) seeks to increase screening in health system clinics through implementation of evidence-based interventions (EBIs) and supporting activities (SAs). This program provided an opportunity to assess the uptake of EBIs and SAs in 355 clinics that participated from 2015 to 2018.
The 30 funded awardees of CRCCP partnered with clinics to implement at least 2 of 4 EBIs that CDC prioritized (patient reminders, provider reminders, reducing structural barriers, provider assessment and feedback) and 4 optional strategies that CDC identified as SAs (small media, professional development and provider education, patient navigation, and community health workers).
Clinics completed 3 annual surveys to report uptake, implementation, and integration and perceived sustainability of the priority EBIs and SAs.
In our sample of 355 clinics, uptake of 4 EBIs and 2 SAs significantly increased over time. By year 3, 82% of clinics implemented patient reminder systems, 88% implemented provider reminder systems, 82% implemented provider assessment and feedback, 76% implemented activities to reduce structural barriers, 51% implemented provider education, and 84% used small media. Most clinics that implemented these strategies (>90%) considered them fully integrated into the health system or clinic operations and sustainable by year 3. Fewer clinics used patient navigation (30%) and community health workers (19%), with no increase over the years of the study.
Clinics participating in the CRCCP reported high uptake and perceived sustainability of EBIs that can be integrated into electronic medical record systems but limited uptake of patient navigation and community health workers, which are uniquely suited to reduce cancer disparities. Future research should determine how to promote uptake and assess cost-effectiveness of CRCCP interventions.
美国的结直肠癌筛查率仍然不理想。疾病控制与预防中心（CDC）的结直肠癌控制计划（CRCCP）旨在通过实施基于证据的干预措施（EBIs）和支持活动（SAs），在卫生系统诊所中增加筛查率。该计划为评估 2015 年至 2018 年期间参与的 355 家诊所采用 EBI 和 SA 的情况提供了机会。
CRCCP 的 30 个资助获得者与诊所合作，实施了 CDC 优先考虑的 4 项 EBI 中的至少 2 项（患者提醒、医生提醒、减少结构障碍、医生评估和反馈）和 CDC 确定的 4 项可选策略作为 SAs（小媒体、专业发展和医生教育、患者导航和社区卫生工作者）。
诊所完成了 3 次年度调查，以报告优先 EBI 和 SAs 的采用、实施、整合和可持续性的感知。
在我们的 355 家诊所样本中，4 项 EBI 和 2 项 SAs 的采用率随着时间的推移显著增加。到第 3 年，82%的诊所实施了患者提醒系统，88%的诊所实施了医生提醒系统，82%的诊所实施了医生评估和反馈，76%的诊所实施了减少结构障碍的活动，51%的诊所实施了医生教育，84%的诊所使用了小媒体。大多数实施这些策略的诊所（>90%）认为它们在第 3 年已完全融入医疗系统或诊所运营，并具有可持续性。较少的诊所使用患者导航（30%）和社区卫生工作者（19%），而且多年来没有增加。
参与 CRCCP 的诊所报告了可集成到电子病历系统中的 EBI 的高采用率和可持续性感知，但对患者导航和社区卫生工作者的采用率有限，而这两者特别适合减少癌症差异。未来的研究应该确定如何促进采用，并评估 CRCCP 干预措施的成本效益。
