Pragmatic Implementation Science Approaches to Assess and Enhance Value of Cancer Prevention and Control in Rural Primary Care

项目摘要/摘要-管理核心我们提议的实施科学中心的主题是“评估和提高农村初级保健中癌症预防和控制的价值的务实实施科学方法”。在资源少、需求大的农村初级卫生保健场所，应用和推进严格但具有普适性的成本效益价值框架、务实方法和措施。这些模型和方法将用于指导癌症预防和控制(CPC)循证计划的选择和实施。我们首先将重点放在农村初级保健环境中的肺癌筛查，首先是在科罗拉多州，然后通过与成熟的初级保健网络(即国家研究网络)的合作，在全国范围内进行肺癌筛查。我们的总体框架将是增强的RE-AIM/PRISM模式，它是广泛使用的REACH、有效性、采用、实施和维护框架的延伸，并增加了背景因素(例如干预特征、实施和可持续性基础设施)。它将作为从不同利益攸关方的角度开发和测试对成本、收益和价值的创新评估的基础，以了解和指导实施。我们将有意义地参与并将患者、提供者和员工利益相关者的观点纳入我们的所有研究。我们的试点实施研究将调整、实施和评估战略，使用利益相关者参与的方法进行价值评估，以指导与肺癌筛查相关的共同决策和戒烟的实施。我们的方法股将改进和评估我们的实用成本评估方法，以从患者、提供者和交付人员(S)的角度确定实施/复制成本，然后制定和试行关于不同RE-AIM结果的相对好处的简要调查方法。然后，我们将评估RE-AIM结果、偏好和不同CPC计划选择之间的关系。最后，我们的外联和网络股将参与a)针对初级和中期调查人员和从业人员的外联活动，包括在线专业发展(例如，研究生证书方案、微型认证)和量身定做的指导和技术援助方法；b)传播活动，以支持研究成果的包装和传播；c)协作活动，利用多种渠道促进方案协调会和执行科学方面的伙伴关系，包括制定共享的实用的D&I措施和数据。

Project Summary/Abstract – Administrative Core The theme of our proposed Implementation Science Center is “Pragmatic implementation science approaches to assess and enhance the value of cancer prevention and control in rural primary care.” We will apply and advance frameworks, pragmatic methods, and measures related to cost, benefits, and value that are rigorous, but also generalizable across rural primary care settings that are often struggling with low resources, and a high need population. These models and methods will be used to guide selection and implementation of evidence-based programs for cancer prevention and control (CPC). We will initially focus on lung cancer screening in rural primary care settings, first in Colorado and then nationally through collaboration with a well- established primary care network (i.e., National Research Network). Our overarching framework will be our enhanced RE-AIM/PRISM model, which is an extension of the broadly used Reach, Effectiveness, Adoption, Implementation, and Maintenance framework with the addition of contextual factors (e.g., Intervention characteristics, implementation and sustainability infrastructure). It will serve as the basis to develop and test innovative assessments of costs, benefits, and value from the perspective of different stakeholders to understand and guide implementation. We will meaningfully engage with and include the perspectives of patients, providers, and staff stakeholders in all our studies. Our pilot Implementation Study will adapt, implement, and evaluate strategies using stakeholder-engaged approaches to value to guide the implementation of shared decision-making and smoking cessation related to lung cancer screening. Our Methods Unit will refine and evaluate our pragmatic cost assessment methods to determine implementation/replication costs from the perspective(s) of patients, providers, and delivery staff and then develop and pilot test brief survey measures of preferences regarding the relative benefit of different RE-AIM outcomes. We will then assess relationships among RE-AIM outcomes preferences and selection of different CPC programs. Finally, our Outreach and Network Unit will engage in a) outreach activities targeted at junior and mid-career investigators and practitioners including online professional development (e.g., graduate certificate program, micro-certification) and tailored mentoring and technical assistance approaches; b) dissemination activities to support the packaging and communication of research findings; and c) collaboration activities to facilitate partnerships on CPC and implementation science using multiple channels and including development of shared pragmatic D&I measures and data.