背景:结直肠筛查,乳房,宫颈癌已被证明可以降低死亡率;然而,并非所有的男性和女性都在美国进行筛查。Further,来自种族和少数族裔群体的人在筛查方面存在差异,低收入人群,缺乏健康保险的人,以及那些无法获得护理的人。疾病控制和预防中心资助了两个计划-结直肠癌控制计划和国家乳腺癌和宫颈癌早期检测计划-以帮助增加在经济和社会上被边缘化的群体中的癌症筛查。本手稿的目标是描述计划及其合作伙伴如何整合基于证据的干预措施(例如,患者提醒)和支持活动(例如,实践促进以优化电子病历)在结直肠,乳房,和宫颈癌筛查,我们建议基于实施科学的研究领域。
方法:我们使用定性和定量数据进行了探索性评估,以描述癌症筛查综合干预措施和支持活动的实施。我们对卫生系统及其合作伙伴进行了10次实地考察和后续电话采访,以告知整合过程。我们开发了一个概念模型来描述整合过程,并审查了美国预防服务工作组的筛选建议,以说明整合中的挑战。为了确定程序实施中的重要因素,我们要求程序实施者对实施研究综合框架的领域和结构进行排名。
结果:卫生系统整合了针对单个和多个级别的所有筛查的干预措施。虽然潜在的效率,由于按年龄划分的筛选资格不同,存在挑战,性别,频率,和服务的位置。程序实施者排名复杂性,成本,实施气候,以及让适当的工作人员参与实施是成功的最重要因素之一。
结论:整合干预措施和支持活动以增加癌症筛查的摄取可能是一种有效和高效的方法,但是我们目前没有证据建议广泛采用。与过程相关的详细多层次措施,筛选,和实施成果,和成本需要评估综合计划。系统研究可以帮助确定综合干预措施和支持多种癌症筛查活动的益处。我们建议研究领域,可能解决目前的文献空白。
BACKGROUND: Screening for colorectal, breast, and cervical cancer has been shown to reduce mortality; however, not all men and women are screened in the USA. Further, there are disparities in screening uptake by people from racial and ethnic minority groups, people with low income, people who lack health insurance, and those who lack access to care. The Centers for Disease Control and Prevention funds two programs-the Colorectal Cancer Control Program and the National Breast and Cervical Cancer Early Detection Program-to help increase cancer screenings among groups that have been economically and socially marginalized. The goal of this manuscript is to describe how programs and their partners integrate evidence-based interventions (e.g., patient reminders) and supporting activities (e.g., practice facilitation to optimize electronic medical records) across colorectal, breast, and cervical cancer screenings, and we suggest research areas based on implementation science.
METHODS: We conducted an exploratory assessment using qualitative and quantitative data to describe implementation of integrated interventions and supporting activities for cancer screening. We conducted 10 site visits and follow-up telephone interviews with health systems and their partners to inform the integration processes. We developed a conceptual model to describe the integration processes and reviewed screening recommendations of the United States Preventive Services Task Force to illustrate challenges in integration. To identify factors important in program implementation, we asked program implementers to rank domains and constructs of the Consolidated Framework for Implementation Research.
RESULTS: Health systems integrated interventions for all screenings across single and multiple levels. Although potentially efficient, there were challenges due to differing eligibility of screenings by age, gender, frequency, and location of services. Program implementers ranked complexity, cost, implementation climate, and engagement of appropriate staff in implementation among the most important factors to success.
CONCLUSIONS: Integrating interventions and supporting activities to increase uptake of cancer screenings could be an effective and efficient approach, but we currently do not have the evidence to recommend widescale adoption. Detailed multilevel measures related to process, screening, and implementation outcomes, and cost are required to evaluate integrated programs. Systematic studies can help to ascertain the benefits of integrating interventions and supporting activities for multiple cancer screenings, and we suggest research areas that might address current gaps in the literature.