Using Context to Improve Implementation of Evidenced-based Interventions for Colorectal Cancer Screening in Rural Primary Care (Precise CRC)

利用背景改善农村初级保健中结直肠癌筛查循证干预措施的实施（精准 CRC）

• 批准号: 9386322
• 负责人: Melinda Marie Davis
• 金额: $ 17.06万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9386322
• 关键词: Address; Adult; Area; Awareness; Cancer Control; Cancer Control Research; Caring; Clinic; Clinical Research; Colonoscopy; Colorectal Cancer; Communities; Consent; Data; Doctor of Philosophy; Electronic Mail; Eligibility Determination; Ensure; Environment; Evidence based intervention; Face; Family Practice; Goals; Growth; Health; Health Planning; Health Sciences; Health behavior; Individual; Information Technology; Institutes; Intervention; Intervention Studies; Interview; Knowledge; Leadership; Low Income Population; Low income; Malignant Neoplasms; Medicaid; Mentors; Methods; Modality; Modeling; Oregon; Outcome; Patients; Performance; Persons; Phonation; Population; Pragmatic clinical trial; Primary Health Care; Provider; Public Health Schools; Readiness; Research; Research Activity; Research Assistant; Research Design; Research Infrastructure; Research Institute; Research Methodology; Research Personnel; Rural; Secure; Surveys; System; Telephone; Testing; Time; Training; Training Activity; Translational Research; Universities; Visit; Work; arm; authority; cancer care; cancer prevention; care delivery; career development; clinical care; colorectal cancer screening; cost; design; developmental psychology; evidence base; experience; follow-up; implementation research; implementation science; improved; informant; medical schools; multi-component intervention; multidisciplinary; multimodality; practice-based research network; professor; programs; response; routine practice; rural patients; rural setting; rural underserved; screening; skills; social; treatment as usual

PROJECT SUMMARY Candidate: Dr. Melinda Davis has a PhD in social developmental psychology and is a Research Assistant Professor in the Oregon Health & Science University (OHSU) School of Medicine (Department of Family Medicine) and Assistant Professor in the OHSU-PSU School of Public Health (Health Behavior). She is the Director of Community Engaged Research for the Oregon Rural Practice-based Research Network (ORPRN) at OHSU. This K07 builds upon her applied experience as a practice facilitator and participatory researcher, addresses critical gaps in scientific training, and provides pilot data for an R01 submission in year 3 in response to PAR-16-238. Guided by a multidisciplinary team of mentors, Dr. Davis will, through this K07, consolidate her skills in implementation science, mixed-methods, and cancer prevention and control. She will also secure her transition to research independence. Research Focus: Bridging the gap between knowledge of evidence based interventions (EBIs) and application in “real world” settings is a critical issue in cancer prevention and control research. Screening for colorectal cancer (CRC) saves lives, yet disparities exist for rural and low-income populations. Although direct mail (DM) programs can increase CRC screening rates by nearly 40%, this EBI is not yet routine practice. Moreover, implementation and intervention outcomes vary widely across settings. Research is needed to inform how best to scale DM programs and to support follow-up colonoscopy on positive fecal tests. Guided by the social ecological model and consolidated framework for implementation research we propose three aims: Aim 1: Identify factors associated with higher levels of primary care practice readiness to implement direct mail programs to increase colorectal cancer (CRC) screening. H1: Leadership culture and higher levels of adaptive reserve will be associated with readiness. Aim 2: Pilot test tailored implementation support for a direct mail program in four rural primary care practices clustered in one Medicaid Accountable Care Organization (ACO). Aim 3: Elucidate barriers, facilitators, and adaptations to direct mail program components and the associated impact on implementation and intervention outcomes. Training Goals: The training proposed fills critical gaps to enable Dr. Davis to conduct trials to improve the identification, adaptation, and implementation of EBIs to improve cancer prevention in rural primary care. The mentoring, training, and research aims ensure scientific growth in three areas: (1) Knowledge of advanced implementation science research methods; (2) Mixed methods research design and analysis; and (3) Leading multidisciplinary teams in cancer prevention and control. Environment: The OHSU Department of Family Medicine provides institutional support for this K07. Research and training activities also utilize the robust infrastructure of the Oregon Rural Practice-based Research Network (ORPRN), Oregon Clinical and Translational Research Institute (OCTRI), Knight Cancer Institute, and the Kaiser Permanente Northwest Center for Health Research. Methods: We will use an intervention mixed method design with embedded convergent and sequential components. To achieve Aim 1, we will conduct a multimodal (email, phone, in-person) survey of ORPRN practices (N~190), which are spread across Oregon's 16 Medicaid ACOs. We use generalized linear mixed models to identify factors associated with higher levels of readiness. To achieve Aim 2, we will use practice facilitation informed by the Getting to Outcomes™ approach, an evidence-based model that uses 10 steps to help organizations implement EBIs, to implement DM programs into four rural primary care clinics clustered in one Medicaid ACO (PacificSource Health Plans). We will assess the number of eligible patients reached (implementation outcomes) and the impact on CRC screening (intervention outcomes) and use a merging approach to cross-tabulate findings from clinic performance data with qualitative themes from observation visits and a baseline assessments of adaptive reserve and practice-readiness. In Aim 3, we will interview key informants from each practice (N~20) to identify DM program adaptations and elucidate barriers and facilitators to implementation. Outcomes: The training and research activities in this K07 fill critical gaps in scientific training for Dr. Davis. Findings provide essential pilot data on practice readiness, implementation strategies, and intervention adaptations which will inform an R01 submission in year 3 in response to PAR-16-238 to scale DM programs across rural clinics served by Oregon's Medicaid ACOs in a two arm pragmatic clinical trial. Findings address NCI agency priorities to implement EBIs and study multilevel interventions, help address long-standing CRC screening disparities, and propel Dr. Davis to research independence.

项目总结 候选人：梅琳达·戴维斯博士拥有社会发展心理学博士学位，是一名研究助理 俄勒冈健康与科学大学(OHSU)医学院(家庭系)教授 OHSU-PSU公共卫生学院(健康行为)助理教授。她就是那个 俄勒冈州农村实践研究网络(ORPRN)社区参与研究主任 在俄亥俄大学。这个K07建立在她作为实践促进者和参与式研究员的应用经验的基础上， 解决科学培训方面的关键差距，并为#年第3年的R01提交提供试点数据 对PAR-16-238的响应。在多学科导师团队的指导下，戴维斯博士将通过这次K07， 巩固她在实施科学、混合方法和癌症预防与控制方面的技能。她会的 也确保了她向研究独立的过渡。 研究重点：弥合循证干预(EBI)知识与 在“真实世界”环境中的应用是癌症预防和控制研究中的一个关键问题。筛选 结直肠癌(CRC)挽救了生命，但农村和低收入人口之间存在差异。虽然直接 邮件(DM)计划可以将CRC筛查率提高近40%，这种EBI尚未成为常规做法。 此外，实施和干预的结果在不同的环境中差别很大。需要研究来 告知如何最好地扩大DM计划，并支持粪便检测阳性的后续结肠镜检查。指导原则 社会生态模型和实施研究的综合框架我们提出了三个目标： 目标1：确定与更高水平的初级保健实践准备有关的因素，以实施直接 增加结直肠癌(CRC)筛查的电子邮件计划。 H1：领导力文化和更高水平的适应性储备将与准备就绪相关。 目标2：在四个农村初级保健中试点测试为直接邮寄计划量身定做的实施支持 实践聚集在一个医疗补助责任护理组织(ACO)中。 目标3：阐明直接邮件程序组件和 对执行和干预结果的相关影响。 培训目标：拟议的培训填补了关键空白，使戴维斯博士能够进行试验，以改善 确定、适应和实施EBIs，以改善农村初级保健中的癌症预防。这个 指导、培训和研究的目的是确保三个领域的科学发展：(1)先进的知识 实施科学研究方法；(2)混合方法研究设计和分析；(3)领先 癌症预防和控制中的多学科团队。 环境：OHSU家庭医学部为K07提供机构支持。研究 培训活动还利用了俄勒冈州农村实践研究的强大基础设施 网络(ORPRN)、俄勒冈州临床和翻译研究所(OCTRI)、奈特癌症研究所和 凯撒永久西北健康研究中心。 方法：采用嵌入性收敛和序贯混合干预设计 组件。为了实现目标1，我们将对ORPRN进行多模式(电子邮件、电话、面对面)调查 做法(N~190)，分布在俄勒冈州的16个医疗补助ACO。我们使用广义线性混合 确定与更高级别的就绪性相关的因素的模型。为了达到目标2，我们将用实践 通过Get to Results™方法进行促进，这是一种基于证据的模式，使用10个步骤来 帮助组织实施EBIS，将DM计划实施到四个农村初级保健诊所 一份医疗补助ACO(太平洋来源健康计划)。我们将评估符合条件的患者人数 (执行结果)和对儿童权利委员会筛查的影响(干预结果)，并使用合并 将临床表现数据的结果与观察访问的定性主题交叉列表的方法 以及适应性储备和实践准备的基线评估。在目标3中，我们将采访Key 来自每个实践(N~20个)的告密者，以确定DM计划的适应情况并阐明障碍和促进者 到实施。 结果：本次K07的培训和研究活动填补了戴维斯博士在科学培训方面的关键空白。 调查结果提供了有关实践准备情况、实施战略和干预措施的基本试点数据 将根据PAR-16-238在第3年提交R01以扩展DM计划的调整 在俄勒冈州医疗补助ACO服务的乡村诊所进行了一项务实的双臂临床试验。调查结果地址 NCI机构优先实施EBIS和研究多层次干预措施，帮助解决长期存在的CRC问题 筛查差异，并推动戴维斯博士进行独立研究。