Parkland-UT Southwestern PROSPR Center: Colon cancer screening in a safety net
in summary, we have constructed our PRoSPR Center and transdisciplinary study team to build the foundation for improving the CRC screening process through an integrated approach to all of our Cores and Projects. The design, measurement and analysis plan for all Projects are based on the Taplin conceptual model of the screening process continuum. all Projects share overlapping aspects of our theme to optimize CRC screening through personalized regimens in our integrated safety-net clinical provider network serving a large and diverse population of under- and un-insured patients in Dallas. We propose three distinct Projects which are complementary and synergistic, and include efforts to improve the screening process through patient-level in-reach, system-wide outreach, and clinic-level identification of best organizational practices. The closely linked SPDu and SRRC will provide a strong, coordinated data extraction, management and analysis backbone and assure harmonized terminology regarding benefits, harms, and costs, data definitions, and analysis approaches. The five-decade-long, close-knit relationship between the Parkland Clinical Provider network and uT Southwestern together with the history of productive, transdisciplinary collaborations among the PRoSPR Program Co-Directors, Core Directors, and Project Leaders, are additional fundamental strengths of this proposal. our approach builds directly on the experience and preliminary work of our trans-disciplinary team with broad content and methodological expertise. Finally, we have structured our PRoSPR Center to not only accomplish the five-year aims of all the Cores and Projects, but to build lasting, population-based, clinical research infrastructure, broad trans-disciplinary expertise, leadership and teamwork, and mutually beneficial inter-institutional collaborations to facilitate successful involvement in future PRoSPR network and nCi-funded trials and cohort studies of a variety types of cancer. The large, diverse, vulnerable populations cared for by our population-based, eMR-savvy, integrated safety-net delivery system will be a promising natural laboratory for many types of externally funded research projects going forward.
The primary study population for the Screening Process Documentation unit (SPDu) will be unique individuals age 49 years or older who receive their primary care in the Parkland system. We propose to leverage and expand the existing population science research infrastructure and expertise at uT Southwestern and the Parkland Center for Clinical innovation to track the processes and outcomes of the CRC screening process continuum for a large, population-based cohort of vulnerable patients cared through our Parkland Clinical Provider network (CPn).
The screen-eligible population for the SPDU/SRRC will be any Dallas county resident age 49 to 64 years old with at least one visit to a Parkland adult primary care clinic in the past 18 months (January 1, 2010xSeptember 30, 2011) or become eligible during the study period (October 1, 2011xSeptember 30, 2016). This method of continued rolling recruitment will maximize identification of screen-eligible patients. We will continue to follow patients in the study cohort database and collect EMR data until the conclusion of the study. No racial or ethnic group will be excluded from participation.