COLORECTAL CANCER SCREENING IN PRIMARY CARE PRACTICE

描述(由申请人提供)： 在美国，结直肠癌(CRC)是癌症死亡的第二大原因，及早发现和治疗这种疾病和前驱病变可以预防许多此类死亡。然而，大多数美国成年人没有接受过结直肠癌筛查，而改进的结直肠癌筛查是美国2010年健康人群目标的一个组成部分。实践伙伴研究网络(PPRNet)是一个以实践为基础的研究网络，由在33个州使用共同电子病历(EMR)的初级保健提供者组成，它开发了一种成功地将心血管研究转化为初级保健实践的质量改进模式，称为PPRNet-Trip。PPRNet-Trip结合了循证质量理念的优先顺序，涉及所有员工(团队合作)、交付系统重新设计、患者激活以及用于个性化和基于人群的医疗的EMR工具。PPRNet-Trip在实践环境中通过实践绩效报告、实践现场访问、网络会议和基于网络的工具相结合来实施。申请中提出的活动的目的是通过在30个初级保健实践中进行的随机对照临床试验来评估PPRNet-Trip是否也可以改善提供者的建议和患者对结直肠癌筛查的接受情况。该项目为期4年，为期两年。15个练习将被随机分配给对照组，15个练习被分配给干预组。对照组做法将收到结直肠癌筛查指南。干预小组实践者将收到儿童疾病筛查业绩报告，并参加每年两次的实践现场访问和年度研究会议，以帮助他们采用PPRNet-Trip改进模式进行儿童儿童疾病筛查。两年后，将评估干预措施对儿童权利委员会筛查、建议和完成工作的影响。还将进行混合方法进程评估，以评估在参与实践中采用PPRNet-Trip的情况。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second leading cause of cancer death in the United States and early detection and treatment of the illness and precursor lesions can prevent many of these deaths. Yet a majority of American adults have not received CRC screening, and improved CRC screening is one component of the nation's Healthy People 2010 goals. The Practice Partner Research Network (PPRNet), a practice-based research network among primary health care providers practicing in 33 States who use a common electronic medical record (EMR), has developed a quality improvement model for successfully translating cardiovascular research into primary care practice termed PPRNet-TRIP. PPRNet-TRIP incorporates prioritization of evidence-based quality philosophies, involving all staff (teamwork), delivery system redesign, patient activation, and EMR tools for individualized and population-based medicine. PPRNet-TRIP is implemented in practice settings through a combination of practice performance reports, practice site visits, network meetings, and web-based tools. The purpose of the activities proposed in the application is to assess, through a randomized controlled clinical trial in 30 primary care practices whether PPRNet-TRIP can also improve provider recommendation and patient receipt of CRC screening. The project will be 4 years in duration, with a two-year intervention. Fifteen practices will be randomly allocated to a control group and 15 to an intervention group. Control group practices will receive CRC screening guidelines. Intervention group practices will receive CRC screening performance reports and participate in twice-yearly practice site visits and annual research meetings to help them adopt the PPRNet-TRIP improvement model for CRC screening. After two years the impact of the intervention on CRC screening recommendation and completion will be assessed. A mixed-method process evaluation will also be conducted to assess the adoption of PPRNet-TRIP within participating practices.