The Colorectal Cancer Screening Process in Community Settings: A Conceptual Model for the Population-Based Research Optimizing Screening through Personalized Regimens Consortium

Abstract

Reducing colorectal cancer (CRC) mortality by promoting screening has been a national goal for two decades. The National Cancer Institute's Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium is the first federal initiative to foster coordinated, transdisciplinary research evaluating the entire cancer screening process in community settings. PROSPR is creating a central data repository to facilitate research evaluating the breast, cervical, and CRC screening process across different patient populations, provider types, and delivery systems. Data are being collected and organized at the multiple levels in which individuals are nested (e.g., healthcare systems, facilities, providers, patients). Here, we describe a conceptual model of the CRC screening process guiding data collection and highlight critical research questions that will be addressed through pooled data. We also describe the three Research Centers focused on CRC screening with respect to study populations, practice settings, and screening policies. PROSPR comprehensively elucidates the complex screening process through observational study, and has potential to improve care delivery beyond the healthcare systems studied. Findings will inform intervention designs and policies to optimize CRC screening delivery and advance the Institute of Medicine's goals of effective, efficient, coordinated, timely, and safe health care with respect to evidence-based cancer screening.

Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium

“…The health systems also differed in the types of fecal tests (FOBT and FIT) and processors used during the years studied. 7 The lower abnormality rate found for GH in comparison to KP could reflect the use of the FOBT (used at some GH clinics through 2011), which is more specific and less sensitive than FIT (used at KP). 23 For cervical cancer screening, the higher variation in abnormality rates may be attributable to the diverse populations served at specific clinics and to the fact that we did not restrict analysis to primary care clinics or providers.…”

“…An essential premise in establishing PROSPR, initially comprised of three centers focused on breast cancer, three on colorectal cancer, and one on cervical cancer screening, is that variation at multiple levels-health system, clinic, provider, and patient-may be leveraged through comparative effectiveness research to elucidate best cancer screening practices. To advance research in this area, the consortium has developed conceptual models for studying screening processes of care [5][6][7] that extend the work of Zapka and Taplin. 8 These models detail the screening process from risk assessment through diagnosis and treatment as steps with interfaces requiring a transfer of information and/or responsibility across providers, and elucidate transitions where threats to timely follow-up may occur at multiple levels.…”

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

“…[16][17][18] The overall aim of PROSPR is to conduct multi-site, coordinated, transdisciplinary research to evaluate and improve cancer screening processes. The ten PROSPR research centers reflect the diversity of US delivery system organizations.…”

“…The populations and screening practices of the PROSPR sites have been described previously. 17 The four participating systems have different CRC screening strategies. The two Kaiser Permanente health systems have active outreach programs that include annual mailing of FIT kits to patients not up to date with screening, supplemented by distribution of FIT kits in other settings (e.g.…”

Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System

“…This study was conducted within the National Cancer Institutefunded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. 30 …”