The Parkland-UT Southwestern PROSPR Center represents a fully coordinated, trans-disciplinary partnership of the Parkland Health System, UT Southwestern Medical Center, Simmons Cancer Center, and UT School of Public Health. Our goal is to optimize colon cancer screening through personalized regimens in our integrated safety-net clinical provider network serving a large and diverse population of under- and uninsured patients in Dallas. Three interlocking research projects will assess clinic, system, and organizational factors associated with over-, under- and guideline-based screening among this vulnerable population, and will compare benefits, harms, and costs of strategies for facilitating optimized screening regimens. Project 1 employs an "in-reach" strategy by implementing innovative, algorithmically driven tools in primary-care and colonoscopy clinics to collect information including patients'familial risk factors and colonoscopy findings to: identify personalized guideline-based screening regimens;characterize under- and over-screening. Project 2, a comparative effectiveness trial, compares benefits, harms and costs resulting from two system level, mailed outreach strategies for promoting effective screening: the first strategy begins with a mailed fecal immune-histochemical test kit;the second begins with a mailed invitation for colonoscopy;both include centralized processes to assure guideline-based follow up. Project 3 characterizes organizational factors at the network and clinic level that contribute to completion of screening processes and examines which organizational factors modify relationships between social disadvantage and completion of guideline-based screening processes. Parkland, the sole safety-net provider in Dallas County, is a vertically integrated delivery system that includes 11 primary care clinics caring for 32,000 adults (50-64 yrs) and has a comprehensive electronic record through which eligibility for a test, test ordering, results, referrals, and treatment are ascertainable. Through these capabilities, the Screening Process Documentation Unit will: collect accurate, clinically detailed data on all relevant processes and outcomes across the screening process, and link to the ACCR Gold-Star Texas Cancer Registry;facilitate data transfers to the national data coordinating center;and work closely with the Shared Research Resources Core to provide all data needed for Projects 1-3.
Colorectal cancer is the 2nd cancer killer despite the fact that effective screening saves lives. Low-income and minority patients in safety-net health systems are least likely to receive effective screening. To address these disparities, our PROSPR Center will develop new tools to improve screening in clinics, compare benefits and harms of two common outreach strategies for promoting screening, and identify clinic policies and procedures that lead to best practices for effective screening.
|Gupta, Samir; Sussman, Daniel A; Doubeni, Chyke A et al. (2014) Challenges and possible solutions to colorectal cancer screening for the underserved. J Natl Cancer Inst 106:dju032|
|Murphy, Caitlin C; Vernon, Sally W; Diamond, Pamela M et al. (2014) Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence mammography behavior? Ann Behav Med 47:120-9|
|Tiro, Jasmin A; Kamineni, Aruna; Levin, Theodore R et al. (2014) The colorectal cancer screening process in community settings: a conceptual model for the population-based research optimizing screening through personalized regimens consortium. Cancer Epidemiol Biomarkers Prev 23:1147-58|
|Gupta, Samir; Sun, Han; Yi, Sang et al. (2014) Molecular markers of carcinogenesis for risk stratification of individuals with colorectal polyps: a case-control study. Cancer Prev Res (Phila) 7:1023-34|
|Pruitt, Sandi L; Leonard, Tammy; Zhang, Song et al. (2014) Physicians, clinics, and neighborhoods: multiple levels of influence on colorectal cancer screening. Cancer Epidemiol Biomarkers Prev 23:1346-55|
|Gupta, Samir; Halm, Ethan A; Rockey, Don C et al. (2013) Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: a randomized clinical trial. JAMA Intern Med 173:1725-32|
|Khatami, Shabnam; Xuan, Lei; Roman, Rolando et al. (2012) Modestly increased use of colonoscopy when copayments are waived. Clin Gastroenterol Hepatol 10:761-766.e1|