Objectives: The objective of this K24 proposal is to enable the candidate to mentor young investigators to successfully integrate clinical, outcomes and health services research methods to optimize management strategies for gastrointestinal disease. Background: The candidate has a successful program of patientoriented research in gastrointestinal disease. He has obtained independent NIH funding for his research, and has an established record of mentoring young investigators who have been successful in conducting patientoriented research, publishing in peer-reviewed journals and obtaining NIH support in the form of K-awards. The candidate has been invited to teach patient-oriented research design to national and international audiences, and publish reviews of research techniques in leading journals. Methods: Mentoring plan: The candidate's environment allows new investigators to obtain formal training in clinical study design, epidemiology and biostatistics. Specific goals for the candidate include formal coursework in health economic theory and participation in the UCSF Clinical and Translational Science Institute Mentor Development Program. The candidate proposes to teach quantitative analysis in order to generate hypotheses, which can be tested through properly designed prospective clinical trials. Data derived from these studies can be integrated into revised decision models to identify the optimal competing strategies of management, which can then be prospectively tested. An example testing this hypothesis is presented as a research project, which uses the infrastructure established by the candidate's R01 project to recruit and follow subjects. Research plan: The effectiveness of strategies to screen for colorectal neoplasia depends heavily on the rate of adherence between screening tests. This study aims to identify factors associated with non-adherence to colorectal neoplasia screening in a vulnerable population at high-risk for poor health outcomes. We are conducting a prospective cohort study of patients at average risk for development of polyps in which subjects receive counseling about screening using fecal occult blood testing or colonoscopy or their choice of either test. This proposal adds a survey to identify factors based on the Health Belief Model, including sociodemographic variables that predict non-adherence to screening. Data Collection: 1. The primary outcome is identification of variables associated with non-adherence. Data Analysis: Chi-square testing of proportions and generalized linear models. Public health: This grant will support mentorship of new investigators interested in patient-oriented research in gastrointestinal disease.
We aim to identify important questions through quantitative analysis and then definitively answer these questions through prospective clinical trials. The research project will provide targets for intervention to increase screening adherence for pre-malignant colorectal neoplasia, focusing on vulnerable populations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24DK080941-03
Application #
7882311
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
Project Start
2008-07-01
Project End
2010-08-31
Budget Start
2010-07-01
Budget End
2010-08-31
Support Year
3
Fiscal Year
2010
Total Cost
$38,839
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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Heberle, Curtis R; Omidvari, Amir-Houshang; Ali, Ayman et al. (2017) Cost Effectiveness of Screening Patients With Gastroesophageal Reflux Disease for Barrett's Esophagus With a Minimally Invasive Cell Sampling Device. Clin Gastroenterol Hepatol 15:1397-1404.e7
Liang, Peter S; Mayer, Jonathan D; Wakefield, Jon et al. (2017) Temporal Trends in Geographic and Sociodemographic Disparities in Colorectal Cancer Among Medicare Patients, 1973-2010. J Rural Health 33:361-370
Wernli, Karen J; Brenner, Alison T; Rutter, Carolyn M et al. (2016) Risks Associated With Anesthesia Services During Colonoscopy. Gastroenterology 150:888-94; quiz e18
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Liang, Peter S; Wheat, Chelle L; Abhat, Anshu et al. (2016) Adherence to Competing Strategies for Colorectal Cancer Screening Over 3 Years. Am J Gastroenterol 111:105-14
Brenner, Alison Tytell; Gupta, Shivani; Ko, Linda K et al. (2016) Development of a Practical Model for Targeting Patient Decision Support Interventions to Promote Colorectal Cancer Screening in Vulnerable Populations. J Health Care Poor Underserved 27:465-78
Shergill, Amandeep K; Conners, Erin E; McQuaid, Kenneth R et al. (2015) Protective association of colonoscopy against proximal and distal colon cancer and patterns in interval cancer. Gastrointest Endosc 82:529-37.e1
Brenner, Alison Tytell; Ko, Linda K; Janz, Nancy et al. (2015) Race/Ethnicity and Primary Language: Health Beliefs about Colorectal Cancer Screening in a Diverse, Low-Income Population. J Health Care Poor Underserved 26:824-38
Elmunzer, B Joseph; Singal, Amit G; Sussman, Jeremy B et al. (2015) Comparing the effectiveness of competing tests for reducing colorectal cancer mortality: a network meta-analysis. Gastrointest Endosc 81:700-709.e3

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