Focusing Implementation to Bring Effective Reminders: FIBER

描述（由申请人提供）：聚焦实施以带来有效提醒（FIBER）混合方法为期4年的研究将评估大规模基于人群的结直肠癌（CRC）筛查患者提醒计划的实施和协调随访。FIBER将使用由研究人员开发的实用稳健实施和可持续性模型（PRISM）来指导分析。PRISM考虑了干预设计、外部环境、干预实施和维护基础设施以及采用组织及其患者的特征等与项目Reach、Effectiveness、Adoption、implementation和maintenance （RE-AIM评估框架）相关的因素。主要目标：年龄在50-80岁、即将进行结直肠癌筛查的健康计划成员（n= 50,000）；初级保健提供者（PCP）团队（n=265）；咨询专家和主要工作人员（n=45）；俄勒冈州和华盛顿州15个医疗中心的主要卫生保健管理人员和工作人员（n=10）： 1。通过开展一项实用的随机对照试验（RCT） （n= 6000）来评估项目实施对CRC筛查的短期效果和每增加一次CRC筛查的成本，并使用一项CRC筛查的纵向队列研究（n=44,000名未在RCT中的患者）来评估项目在PCP团队水平上的长期有效性和成本，以确定CRC筛查患者提醒计划的有效性和可维护性。2. 阐明患者、PCP团队和系统对实施成功的重要因素。描述和解释在PRISM指导下的CRC筛查患者提醒项目Reach（针对不同患者）、有效性、采用、实施和维护，以授权实施改进以进行进一步评估。4. 结合目标1-3的研究结果和对未来三个传播-实施地点主要工作人员的线人访谈的观点，创建、完善和传播一份CRC筛查提醒项目实施指南。

DESCRIPTION (provided by applicant): The Focusing Implementation to Bring Effective Reminders (FIBER) mixed-methods 4-year study will evaluate the implementation of a large-scale population-based colorectal cancer (CRC) screening patient reminder program and coordinated follow-up. FIBER will use the Practical Robust Implementation and Sustainability Model (PRISM), developed by the investigators, to guide the analyses. PRISM considers elements within the intervention design, external environment, intervention implementation and maintenance infrastructure, and characteristics of the adopting organization and its patients that are associated with program Reach, Effectiveness, Adoption, Implementation, and Maintenance (the RE-AIM evaluation framework). Primary aims: Among health plan members aged 50-80 who are due for colorectal cancer screening (n= 50,000); their primary care provider (PCP) teams (n=265); consulting specialists, and key staff (n=45); and key health care managers and staff (n=10) in 15 medical centers in Oregon and Washington: 1. To determine the Effectiveness and Maintenance of a CRC screening patient reminder program by conducting a practical randomized controlled trial (RCT) (n= 6000) to evaluate the short-term effect of program implementation on CRC screening and the cost per additional CRC screen, and using a longitudinal cohort study of CRC screening (n=44,000 patients not in the RCT) to estimate the longer- term effectiveness and costs of the program at the PCP team level. 2. To elucidate patient, PCP team, and system factors important to implementation success 3. To describe and explain the CRC screening patient reminder program Reach (to diverse patients), Effectiveness, Adoption, Implementation, and Maintenance, guided by the PRISM, to empower implementation improvements for further evaluation. 4. To create, refine, and disseminate an implementation guide for CRC screening reminder programs by combining the findings from Aims 1-3 and the perspectives from informant interviews of key staff at three future dissemination-implementation sites.