DIRECT OBSERVATION OF PRIMARY CARE--CA PREVENTION TRIAL

描述：申请人认为这是第三次申请 用于增加小学预防服务的代际干预措施 关心。他们记录了不遵守预防指南的情况。 医生往往高估了他们提供的预防服务。 单一干预措施，如提醒、审核和反馈，以及患者保留 微型记录可以在实践行为中做出改变。第二代 干预措施提供灵活性，允许个别医生和 选择具体干预措施的做法。第三代干预 提供从有效的单一干预和定制菜单中进行选择 他们要根据个人的需要和特点进行实践。 具体目的是：1)评估这一干预措施的效果 向符合条件的患者提供癌症预防服务的水平；2) 评估干预措施对分娩的辅助作用 服务、执业环境、患者、医生和办公室；3) 评估协变量对干预效果的影响；以及4) 描述和评估医生和执业医生的变化过程 行为。 与这些具体目标相关的主要假设有16个。这个 应用程序为这些假设中的每一个都提供了理由。在 分析部分，为每个假设勾勒出一个分析策略。 样本将是参与先前研究的138名医生。 干预措施将由一名律师按计划访问每个诊所四次 护士-辅导员，有后续电话呼叫。护士促进者 将首先进行一次迎新访问。两周后，访问将 重点准备实践，以实施必要的更改，以 增加对预防模式的利用。这些都将被选中 从菜单上。每次练习将指派一名练习小组组长，该组长将 作为研究的主要联系人。在第三次访问中， 护士辅导员将提供个性化的干预材料， 已经为练习做好了准备。这将在一周前发生 至实施日期。每月都会有几个电话打给 实践领导在实施过程中讨论问题。这个 最后一次访问将在干预开始七个月后进行。 这将是在世界银行进行为期六个月的结果评估后一个月 研究助理。数据将从结果评估到 向实践提供反馈并允许有机会微调 干预。

DESCRIPTION: The applicants consider this application to be a third generation intervention for increasing the delivery of prevention in primary care. They document the lack of adherence to prevention guidelines. Physicians tend to overestimate their delivery of prevention services. Single interventions such as reminders, audit and feedback, and patient-held mini-records can make changes in practice behavior. Second generation interventions provide flexibility by allowing individual physicians and practices to choose specific interventions. A third generation intervention offers choices from a menu of effective single interventions, and tailors them to the individual needs and characteristics of the practice. The Specific Aims are to: 1) evaluate the effect of this intervention on the level of cancer preventive service delivery to eligible patients; 2) evaluate the ancillary effects of the interventions on delivery of other services, the practice environment, patients, physicians and office; 3) evaluate the effect of co-variates on the effect of the intervention; and 4) describe and evaluate the process of change in physician and practice behavior. There are 16 major hypotheses associated with these Specific Aims. The application provides a rationale for each of these hypotheses. In the analysis section, an analysis strategy is outlined for each the hypotheses. The sample will be 138 physicians who participated in the previous study. The intervention will be four scheduled visits to each practice by a nurse-facilitator with follow-up telephone calls. The nurse-facilitator will first conduct an orientation visit. Two weeks later the visit will focus on preparing the practice to implement the changes necessary to increase the utilization of prevention modalities. These will be chosen from a menu. Each practice will assign a practice team leader, who will serve as the main contact to the study. On the third visit, the nurse-facilitator will deliver the personalized intervention materials that have been prepared for the practice. This will occur within one week prior to the implementation date. Several monthly phone calls will be made to the practice leader to discuss problems with the implementation process. The last visit will occur seven months after the initiation of the intervention. This will be one month after the six-month outcome assessment by the research assistant. Data will be available from the outcome assessment to provide feedback to the practice and allow an opportunity to fine tune the intervention.