Behavioral Economics and Population-based Colorectal Cancer Screening

项目总结/摘要 该提案描述了一个为期5年的培训和指导研究的综合计划， 从事医疗保健服务研究的学术生涯。我是一名医学和卫生政策助理教授， 宾夕法尼亚大学我的目标是成为一名独立调查员， 系统可以利用社会科学的新见解来改善结直肠癌的可及性和质量 (CRC)筛选虽然我在临床胃肠病学和回顾性健康方面有很强的背景， 服务研究，我将接受定性研究的额外教学和经验培训， 临床试验的方法学问题和实施科学。在宾夕法尼亚大学，我会 利用经验丰富的指导团队，与医疗保健提供系统的密切合作关系， 以及佩雷尔曼医学院行为经济学和消费者营销方面的专业知识， 沃顿商学院 CRC是美国癌症死亡的第二大原因。尽管有有效的战略， 预防，早期发现和治疗，以及积极的公共卫生工作，以促进筛查，国家 率限制在62-65%，美国目前主要依靠初级保健提供者建议 筛选那些谁参加了办公室访问。一直在努力建立积极主动和有组织的儿童权利委员会 筛查计划，但尚未被广泛采用。 我将与宾夕法尼亚大学卫生系统的初级保健服务线合作， 在东部最大的卫生系统内拥有65个不同的初级保健实践的学术卫生系统 宾夕法尼亚和新泽西。我会进行一个反复的试验， 向符合条件的患者提供制备试剂盒，以促进CRC筛查的参与（目标1）。那我就 在1182名合格患者中进行了一项3组实用RCT，以评估是否有其他方法提供 结肠镜检查准备包可以提高反应率（目的2）。准备工具包是一种金融工具， 激励，调用互惠规范，框架参与作为默认，创建一个捐赠， 减轻了患者的负担。最后，我将对患者和实践进行定性访谈， 了解他们在CRC筛查外展方面的经验，并制定完善的新方法（目标3）。 这项工作将为我提供技能和初步的数据，以申请外部资金，以支持一个 一项实用的试验，评估基于人群的CRC筛查的多水平方法。在这一结论 我将接受严格的研究培训，以补充现有的技能，我将完成一个项目申请 行为经济学和消费者营销的原则，以CRC筛选，我将提交一份竞争力 申请R级奖，以资助一项评估国家科学方法实施情况的试验 到CRC筛查外展。

PROJECT SUMMARY/ ABSTRACT This proposal describes a 5-year comprehensive program of training and mentored research for an academic career in health care delivery research. I am an Assistant Professor of Medicine and Health Policy at the University of Pennsylvania. My goal is to become an independent investigator evaluating how health systems can leverage new insights from social science to improve access to and quality of colorectal cancer (CRC) screening. While I have a strong background in clinical gastroenterology and retrospective health services research, I will receive additional didactic and experiential training in qualitative research, methodological issues of clinical trials, and implementation science. At the University of Pennsylvania, I will take advantage of an experienced mentorship team, close partnership with the health care delivery system, and expertise in behavioral economics and consumer marketing across the Perelman School of Medicine and the Wharton School. CRC is the second leading cause of cancer death in the United States. Despite effective strategies for prevention, early detection, and treatment, and aggressive public health efforts to promote screening, national rates are limited at 62-65% The US currently relies predominantly on primary care providers to recommend screening to those who attend an office visit. There have been efforts to create proactive and organized CRC screening programs, but they have not been broadly adopted. I will collaborate with the primary care service line at the University of Pennsylvania Health System, an academic health system with 65 diverse primary care practices within the largest health system in Eastern Pennsylvania and New Jersey. I will conduct an iterative pilot of a proactive process to send colonoscopy preparation kits to eligible patients as a way to facilitate CRC screening participation (Aim 1). Then, I will conduct a 3-arm pragmatic RCT among 1182 eligible patients to evaluate if alternative ways of offering the colonoscopy preparation kit can increase response rates (Aim 2). The preparation kit is a form of a financial incentive that invokes norms of reciprocity, frames participation as the default, creates an endowment, and reduces the burden of patient effort. Finally, I will perform qualitative interviews with patients and practices to understand their experience with CRC screening outreach and develop refined and new approaches (Aim 3). This work will provide me with skills and preliminary data to apply for external funding to support a pragmatic trial evaluating a multi-level approach to population-based CRC screening. At the conclusion of this award, I will receive rigorous research training to complement existing skills, I will complete a project applying principles of behavioral economics and consumer marketing to CRC screening, and I will submit a competitive application for an R-level award to fund a trial evaluating the implementation of a state-of-the-science approach to CRC screening outreach.