Leveraging implementation science to accelerate adoption of shorter-course radiation for breast and prostate cancer

项目总结/摘要 本NCI K 08职业发展提案的总体目标是促进艾琳吉莱斯皮博士的 发展成为癌症健康服务研究的独立调查员，专注于 提高放射肿瘤学的质量和循证护理。该提案的重点是缩短 从7-9周到3-5周的放射过程（称为“低分割”）， 等效的癌症控制，改善患者报告的结果，并降低乳腺癌患者的费用 和前列腺癌。然而，通过的速度很慢。吉莱斯皮博士先前的研究表明， 个体放射肿瘤学家对乳腺癌患者是否接受 低剂量分割或更长的放疗疗程。 总的假设是放射肿瘤学家是决定放射治疗的关键- 制定，利用行为经济学的实施策略将最有可能影响 实践改变。我的主要目标是1）识别和描述阳性偏差放射肿瘤学家 (high hypofractionation的用户），将2）阐明实施策略，并将其与 在各种环境中采用低分割，以及3）试点测试多管齐下的策略， 使用小分割为一项大型实用的多中心对照试验做准备。的基本原理 提出的研究和培训计划的基础是，随着对驱动力的杠杆的新知识， 医生决策（超越知识差距），医疗保健领导者和政策制定者可以最佳地 设计和实施引发变革的系统。吉莱斯皮博士将利用 纪念斯隆凯特琳癌症中心，在那里她是一名教员在放射科 肿瘤学和健康政策与结果中心。她还在社区从事研究- 通过MSK癌症联盟。她的培训计划有实施科学的基础 它结合了大型数据集分析、混合方法和行为经济学理论。 在拟议研究的目标1中，研究人员将分析包括索赔在内的医疗保险数据集 链接到处方放射肿瘤学家和组织，并由AMA主文件补充。他们 将系统地进行放射肿瘤学实施策略的首次评估， 混合方法。最后，在目标3中，研究人员将制定并试点测试一项多管齐下的战略， 目标1-2，包括审计和反馈。这项建议，连同新的技能博士吉莱斯皮将 获得，将产生关于执行战略对取消执行的影响的新知识， 长期辐射-设计最佳策略所需的关键参数，以鼓励医生 采用高值辐射。这将具体支持制定一项执行战略， 在随后的前瞻性随机试验中进行测试，以评估真实的世界疗效。

PROJECT SUMMARY/ABSTRACT The overall goal of this NCI K08 career development proposal is to facilitate Dr. Erin Gillespie’s development into an independent investigator in cancer health services research focusing on strategies to enhance quality and evidence-based care in radiation oncology. This proposal focuses on shortening the course of radiation from 7-9 weeks to 3-5 weeks (called “hypofractionation”) which is associated with equivalent cancer control, improved patient-reported outcomes, and decreased costs in patients with breast and prostate cancer. Nonetheless, adoption has been slow. Dr. Gillespie’s prior work has revealed that the individual radiation oncologist is highly influential in whether patients with breast cancer receive hypofractionation or a longer course of radiation. The overall hypothesis is that radiation oncologists are the linchpin in radiation treatment decision- making, and that implementation strategies that harness behavioral economics will be most likely to impact practice change. My primary objectives are to 1) identify and characterize positive deviant radiation oncologists (high users of hypofractionation) that will 2) elucidate implementation strategies and associate them with adoption of hypofractionation across various settings, and 3) pilot test a multi-pronged strategy that promotes use of hypofractionation in preparation for a large pragmatic multi-center controlled trial. The rationale that underlies the proposed research and training plan is that, with new knowledge about the levers that drive physician decision-making (beyond knowledge gaps), healthcare leaders and policymakers can optimally design and implement systems that evoke change. Dr. Gillespie will harness the resources and expertise at Memorial Sloan Kettering Cancer Center, where she is a faculty member in the Department of Radiation Oncology and the Center for Health Policy and Outcomes. She is also engaged in research in the community- based setting through the MSK Cancer Alliance. Her training plan has a foundation of implementation science that incorporates large dataset analysis, mixed methods, and behavioral economic theory. In Aim 1 of the proposed study, the investigators will analyze a Medicare dataset that includes claims linked to prescribing radiation oncologist and organization, and is supplemented by the AMA Masterfile. They will systematically conduct the first-ever evaluation of implementation strategies in radiation oncology using mixed methods. Lastly, in Aim 3 the investigators will develop and pilot test a multi-pronged strategy informed by Aims 1-2 and including audit and feedback. This proposal, together with the new skills Dr. Gillespie will acquire, will generate new knowledge about the impact of implementation strategies on de-implementation of long-course radiation – key parameters necessary to design optimal strategies to encourage physicians to adopt high value radiation. This will specifically support the development of an implementation strategy that will be tested in a subsequent prospective randomized trial to assess real world efficacy.