Provider Support and Patient Outreach in Lung Cancer Screening

我们建议在四个医疗系统(Christian Care)中进行多水平干预随机试验 健康系统(CCHS)、杰斐逊健康(JH)、利哈伊谷健康网络(LVHN)和宾夕法尼亚健康 (PSH))测试提供者支持干预和患者外展的综合和单独影响 初级保健实践中对SDM和LCS的干预。使用混合方法2x2析因设计，我们初步 将招募28家初级保健诊所和提供者并将其随机分配到提供者支持小组(N=14) 或对照组(N=14)。在三年内，我们还将确定大约4480名患者 有可能符合LCS的条件，并有预定的初级保健探视。每周，我们将分配 确定患者并发起与每个队列的电话联系，以验证筛查资格，获得 同意，并完成基线调查。我们将至少672名患者随机分配到 患者外展组(N=336)或对照组(N=336)。因此，审判将涉及提供者 支持患者外展组、提供者支持组、患者外展组和控制 组。我们将收集卫生系统电子病历(EMR)数据，研究行政数据， 医生和患者调查数据，以及来自医生、执业人员、卫生系统护理的访谈数据 协调员和卫生系统领导人，用于解决试验目标。该试验的具体目的如下 目的1.评估干预对肺癌筛查(LCS)的影响；目的2.评估干预措施 对共同决策的影响(SDM)；目标3.确定筛选的调解人和主持人；以及 4.评估干预实施情况。我们将使用卫生系统电子病历数据，研究行政数据， 提供商基线和终点调查数据，以及患者基线和终点调查数据、焦点组数据、 和卫生系统领导人访谈数据，以确定影响医生、提供者和患者层面的因素 干预对筛查的影响。就总体影响而言，这项试验将确定有效的战略，以 提高初级保健中的SDM和LCS比率，并在卫生系统中实施有效的战略。我们 将通过参与的卫生系统和更多的交流渠道传播研究结果 通过在ClinicalTrials.gov上报告结果，在医疗保健专业组织会议上，通过 地方、州和区域会议，并通过在同行评议的期刊上发表文章。

We propose to conduct a multi-level intervention randomized trial in four health systems (Christiana Care Health System (CCHS), Jefferson Health (JH), Lehigh Valley Health Network (LVHN), and PennState Health (PSH)) to test the combined and separate effects of a provider support intervention and a patient outreach intervention on SDM and LCS in primary care practice. Using a mixed methods 2x2 factorial design, we initially will recruit and randomize 28 primary care practices and providers either to a Provider Support Group (N=14) or a Control Group (N=14). Over three years, we will also identify approximately 4,480 patients who are potentially eligible for LCS and have a scheduled primary care visit. On a weekly basis, we will allocate identified patients to cohorts and initiate telephone contact with each cohort to verify screening eligibility, obtain consent, and complete a baseline survey. We will randomize at least 672 patient participants either to a Patient Outreach Group (N=336) or a Control Group (N=336). Thus, the trial will involve a Provider Support + Patient Outreach Group, a Provider Support Group, a Patient Outreach Group, and a Control Group. We will collect health system electronic medical records (EMRs) data, study administrative data, physician and patient survey data, and interview data from physicians, practice staff, health system care coordinators, and health system leaders for use in addressing trial aims. Specific aims of the trial are as follows: Aim 1. Assess intervention impact on Lung Cancer Screening (LCS); Aim 2. Assess intervention impact on Shared Decision Making (SDM); Aim 3. Identify mediators and moderators of screening; and, Aim 4. Assess intervention implementation. We will use health system EMR data, study administrative data, provider baseline and endpoint survey data, and patient baseline and endpoint survey data, focus group data, and health system leader interview data to identify practice-, provider- and patient-level factors that impact intervention effects on screening. In terms of overall impact, this trial will identify effective strategies for increasing SDM and LCS rates in primary care and for implementing effective strategies in health systems. We will disseminate study findings through communication channels in participating health systems and more broadly by reporting results on ClinicalTrials.gov, at health care professional organization meetings, through local, state and regional conferences, and via publications in peer-reviewed journals.