Focusing Implementation to Bring Effective Reminders: FIBER

描述（由申请人提供）：聚焦实施有效提醒（FIBER）混合方法4年研究将评估大规模基于人群的结直肠癌（CRC）筛查患者提醒计划和协调随访的实施情况。Fiber将使用由调查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中与项目覆盖、有效性、采用、实施和维护（RE-AIM评价框架）相关的要素。主要目标：在俄勒冈州和华盛顿的15个医疗中心中，50-80岁的健康计划成员（n= 50，000）;他们的初级保健提供者（PCP）团队（n=265）;咨询专家和关键工作人员（n=45）;以及关键医疗保健经理和工作人员（n=10）：1。通过进行一项实际的随机对照试验（RCT）（n= 6000）来评估CRC筛查项目实施的短期效果和每次额外CRC筛查的成本，并使用CRC筛查的纵向队列研究，确定CRC筛查患者提醒项目的有效性和维持性（n= 44，000例不在随机对照试验中的患者），以估计PCP团队水平项目的长期有效性和成本。2.阐明患者、PCP团队和系统因素对实施成功的重要性3.描述和解释CRC筛查患者提醒计划的覆盖范围（针对不同患者）、有效性、采用、实施和维护，以PRISM为指导，以授权实施改进以进行进一步评价。4.通过结合目标1-3的结果和未来三个传播实施地点的关键工作人员的知情人访谈的观点，创建、完善和传播CRC筛查提醒计划的实施指南。公共卫生相关性：Fiber致力于填补当地医疗实践如何影响癌症筛查证据翻译的知识空白。Fiber将在将研究成果转化为现实世界实践的日益重要的领域增加越来越多的文献。Fiber的许多发现将在其他临床领域有用，并将广泛适用于旨在改善结直肠癌检测，治疗和生存能力的医疗保健组织。

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. PUBLIC HEALTH RELEVANCE: FIBER focuses on filling the knowledge gap regarding how local health care practices affect the translation of cancer screening evidence. FIBER will add to the growing literature in the increasingly important area of translating research findings into real-world practice. Many of the FIBER findings will be useful in other clinical areas and will be broadly applicable to health care organizations aiming to improve detection, treatment, and survivability of colorectal cancer.