Colorectal Cancer Screening
Conditions
Keywords
disparities, Patient navigation
Brief summary
Patient navigation is an evidence-based strategy to increase screening rates among racial and ethnic minorities, but there is a gap in understanding the multi-level influences on implementation of such programs across primary care practices. The investigators will conduct a stepped-wedge, randomized trial to roll out patient navigation and patient and provider reminders across 15 clinics (3 clinics per step, 5 six-month steps). Implementation strategies will include assessing for readiness, audit and feedback, building a community coalition, engaging consumers, modifying referral tracking, and training and educating clinical stakeholders. The research team will use the electronic health record data with consideration for the Observational Medical Outcomes Partnership (OMOP) Common Data Model, additional patient-reported data, and study tracking logs to measure reach, effectiveness, adoption, implementation, and will use qualitative measures and site observations to document contextual factors, including examination of discrimination in patient experiences and provider referral patterns that may influence intervention delivery or colorectal cancer screening completion.
Detailed description
Colorectal cancer (CRC) screening is recommended by the United States Preventative Services Task Force for adults age 45-75. Patient navigation is an evidence-based strategy to increase screening rates among racial and ethnic minorities. While patient navigation is an evidence-based approach to improve screening, there is a gap in understanding the multi-level influences on implementation of such programs across primary care practices, particularly using a health-equity focused, stakeholder-centered approach. Guided by the Practical, Robust Implementation and Sustainability Model (PRISM) and core health and racial equity principles, the investigative team aims to increase reach of patient navigation and show effectiveness through improvement in the percentage of Black and Hispanic patients completing CRC screening. Investigators will also utilize longitudinal tracking of implementation strategies to better track implementation or intervention adaptations navigation delivery in order to inform future scale up. The research team will conduct a stepped-wedged, randomized trial to roll out patient navigation and patient and provider reminders across 15 clinics (3 clinics per step, 5 six-month steps). Implementation strategies will include assessing for readiness, audit and feedback, building a community coalition, engaging consumers, modifying referral tracking, and training and educating clinical stakeholders. Researchers will use the electronic health record data with consideration for the Observational Medical Outcomes Partnership (OMOP) Common Data Model, additional patient-reported data, and study tracking logs to measure reach, effectiveness, adoption, implementation, and will use qualitative measures and site observations to document contextual factors, including examination of discrimination in patient experiences and provider referral patterns that may influence intervention delivery or CRC screening completion.
Interventions
BEHAVIORALDelivery of patient navigation
Clinics will receive educational materials and access a referral order for patient navigation. Iterative strategies will be used to increase CRC screening
Sponsors
National Committee for Quality Assurance
Medstar Health Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
SCREENING
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Step wedge trial with 5 six-month steps, three clinics at a time, for a total of 15 clinics.
Eligibility
Sex/Gender
ALL
Age
45 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 45-75 * Due for colorectal cancer screening * Identify as Black or Hispanic/Latino * Attend primary care visit at one of the 15 selected clinics within the step time -period
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Colorectal cancer screening completion | 12 months | Completion of any USPSTF approved screening test |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adoption | 6 months | Percent of providers referring to patient navigation |
| Acceptability measured by the Acceptability of Intervention Measure (AIM) | 12 months | Stakeholder assessments of acceptability of navigation and implementation strategies measured on a four-item scale |
| Reach | 6 months | Percent of patients referred out of those eligible |
| Feasibility measured by the Feasibility of Implementation Measure (FIM) | 12 months | Stakeholder assessments of feasibility of navigation and implementation strategies measured on 4 item scale |
| Sustainability measured by the clinical sustainability assessment tool | 12 months | Understanding clinical sustainability of interventions |
| Appropriateness measured by the Intervention Appropriateness Measure (IAM) | 12 months | Stakeholder assessments of appropriateness of navigation and implementation strategies measured on a four-item scale |
Countries
United States
Outcome results
None listed