Rivera Rivera Jessica N, AuBuchon Katarina E, Schubel Laura C, Starling Claire, Tran Jennifer, Locke Marjorie, Grady Melanie, Mete Mihriye, Blumenthal H Joseph, Galarraga Jessica E, Arem Hannah
Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA.
Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Implement Sci Commun. 2024 Jun 3;5(1):60. doi: 10.1186/s43058-024-00598-5.
Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale.
We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions.
Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities.
NCT06401174.
与其他种族群体相比，美国的黑人患结直肠癌（CRC）的发病率和死亡率更高，并且CRC是美国西班牙裔/拉丁裔人群中第二大死亡原因。患者导航是一种基于证据的方法，旨在缩小黑人和西班牙裔/拉丁裔患者在癌症筛查方面的不平等差距。尽管如此，有限的医疗系统已大规模实施患者导航筛查。
我们正在对15家初级保健诊所进行一项阶梯式楔形整群随机试验，试验分为六个阶段，每个阶段为期六个月，以扩大患者导航计划的规模，提高黑人和西班牙裔/拉丁裔患者的筛查率。在进行六个月的无干预基线数据收集后，我们将对诊所进行随机分组，每六个月有三家诊所加入干预组，直到所有诊所都过渡到干预组。在干预推广期间，我们将为诊所开展培训和教育，改变电子健康记录中的基础设施，建立利益相关者关系，评估准备情况，并提供迭代反馈。以实用、稳健实施维持模型（PRISM）为框架，我们将专注于有效性、覆盖面、提供者采用情况和实施情况。我们将记录对患者导航干预措施和实施策略的调整。为了解决健康公平问题，我们将通过访谈和社区咨询委员会，让多层次的利益相关者发表意见，以规划、实施、调整、衡量和传播研究进展。提供者层面的反馈将包括筛查订单和完成情况差异的最新信息。
初级保健诊所有望缩小结直肠癌筛查完成率方面的差距，但可能缺乏对这些差距的严重程度以及如何解决这些差距的了解。我们的目标是了解如何为不同诊所的患者和提供者量身定制结直肠癌筛查的患者导航计划，这些诊所的基线筛查率、支付方组合、与专科护理的距离以及患者数量差异很大。这项研究的结果将为其他初级保健机构和卫生系统提供有效且可持续的策略，以便为少数族裔提供结直肠癌筛查的患者导航服务。
NCT06401174。
