Practice Outcomes in Community & Healthcare Systems

描述（由申请人提供）：初级保健的做法是独特的，以提供有效的预防服务，以大多数美国人。然而，由于大多数做法的变革能力有限，而且与系统和社区资源隔绝，这一潜力尚未得到发挥。 我们先前的研究已经开发了一个社区实践实验室，用于癌症控制研究。在观察性研究中，我们发现了新的实践机会-加强预防的个性化方法。在STEP-UP临床试验中应用这些见解证明了预防服务的可持续增长。多方法过程评估的高和低变化的做法产生了一个新的模式，多层次，多阶段的干预，从事实践，社区和医疗保健系统的资源。 拟定的竞争性继续项目是一项分组随机临床试验。30个初级保健实践，按卫生保健系统隶属关系分层，将被随机分配到初始或延迟干预组。 干预开始于对每种做法及其社区和医疗保健系统的改变能力进行多方法评估。从这一评估中获得的见解将有助于采取参与性办法，建设实践变革能力以及社区和保健系统的联系。这些新的能力和联系随后将被用来调整提供预防性服务的可持续办法。 干预的假设效果将评估：实践的能力变化，美国预防服务工作组推荐的预防服务的交付率，病人和临床医生的满意度。将使用多水平建模来控制组间的聚类和任何基线差异。 将使用一套创新的多方法程序，对变化过程进行评估。由此产生的见解将被用来设计一个完善的多层次干预。这种改进的干预将在延迟干预组中使用前后设计进行实施和评估，而长期结果将在初始干预组中继续评估。由此产生的知识将被传输到其他系统，以提高医疗保健的质量。

DESCRIPTION (provided by applicant): Primary care practices are uniquely situated to deliver effective preventive services to the majority of Americans. However, because of most practices' limited capacity to change and isolation from systems and community resources, this potential has not been met. Our prior research has developed a community practice laboratory for cancer control research. In observational studies we discovered novel opportunities for practice-individualized approaches to enhancing prevention. Applying these insights in the STEP-UP clinical trial demonstrated sustainable increases in preventive service delivery. Multimethod process assessments of high and low change practices produced a new model for a multilevel, multistage intervention that engages practice, community and healthcare system resources. The proposed competing continuation project is a group randomized clinical trial. Thirty primary care practices, stratified by health care system affiliation, will be randomized to initial or delayed intervention groups. The intervention begins with a multimethod assessment of the capacity to change of each practice and its community and healthcare system. Insights from this assessment will inform a participatory approach to building practice change capacity and community and health care system linkages. These new capacities and connections will then be used to tailor sustainable approaches to preventive service delivery. The hypothesized effects of the intervention will be assessed on: practices' capability for change, rate of delivery of US Preventive Services Task Force-recommended preventive services, and patient and clinician satisfaction. Multilevel modeling will be used to control for clustering and any baseline differences between groups. Using an innovative set of multimethod procedures, the process of change will be assessed. The resulting insights will be used to design a refined multilevel intervention. This refined intervention will be implemented and evaluated in the delayed intervention group using a pre-post design, while long-term outcomes continue to be assessed in the initial intervention group. The resulting knowledge will be transportable to other systems seeking to improve the quality of health care.