Observation of Practice Change for Cancer Prevention

旨在增加癌症预防服务提供的临床试验此前已显示出温和的短期效果。需要更好地了解影响干预反应的初级保健做法的特点，以发现在快速变化的卫生保健环境中改进做法的创新新战略。这项竞争性的延续研究建立在一个独特的初级保健实践队列的基础上，这些实践参与了之前两项由NCI资助的研究。初级保健的直接观察研究使用了多种方法来增加对初级保健实践的理解。随后的通过了解实践来加强预防的研究(STEP-UP)是一项临床试验，旨在改善80种实践中的预防性服务提供。这项研究的初步干预(STEP-1)发现，个性化的办公室系统干预增加了以证据为基础的预防服务的全面措施的提供，特别是健康习惯咨询。基于STEP-1的初步见解，制定了一种更全面的实践评估和干预方法(STEP-2)，并在对照(延迟干预)实践中实施。1)观察到对干预措施的高度可变的反应，2)关于实践和卫生系统变化的丰富的纵向数据的可用性，3)卫生系统变化研究中心的独特背景数据的可用性，以及来自社区实践持续评估的新数据，以及4)复杂性科学与理解初级保健实践和卫生系统变化的相关性的发现，为拟议的继续研究提供了独特的机会。这项新的研究旨在：1)全面了解影响初级保健实践对2种不同质量改进干预措施的反应的因素，以提高癌症预防服务的提供率；2)了解卫生保健系统变化对初级保健实践改善癌症预防服务提供能力的影响。这将通过多方法设计来实现，以创建深入的纵向比较案例研究，以确定影响应对干预措施的变化进程的实践和卫生系统特征。拟议的研究将进一步了解影响对质量改进干预措施反应的初级保健做法的特点，并将为增加预防性服务提供的新战略提供信息。

Clinical trials designed to increase cancer preventive service delivery have previously shown modest short term effects. Greater understanding of characteristics of primary care practice that affect response to interventions is needed to discover innovative new strategies for improving practice in a rapidly changing health care environment. This competing continuation study builds on a unique cohort of primary care practices who participated in two prior NCI-funded studies. The Direct Observation of Primary Care Study used a multimethod approach to increase understanding of primary care practice. The ensuing Study To Enhance Prevention by Understanding Practice (STEP-UP) is a clinical trial to improve preventive service delivery in 80 practices. The study's initial intervention (STEP-1) found that an individualized office systems intervention increased delivery of a comprehensive measure of evidence-based preventive services, particularly health habit counseling. Based on preliminary insights from STEP-1, a more comprehensive practice assessment and intervention approach (STEP-2) was developed and implemented in the control (delayed intervention) practices. A unique opportunity for the proposed continuation study is supported by 1) the observation of a highly variable response to intervention, 2) the availability of rich longitudinal data on practices and health systems changes, 3) the availability of unique contextual data from the Center for Studying Health Systems Change and new data from continued assessment of community practices, and 4) the discovery of the relevance of complexity science to understanding primary care practice and health system change. This new study aims to: 1) Develop a comprehensive understanding of factors affecting the response of primary care practices to 2 different quality improvement interventions to increase cancer preventive service delivery rates, and 2) Understand the effect of health care system changes on primary care practices' ability to improve cancer preventive service delivery. This will be accomplished with a multimethod design to create in- depth longitudinal comparative case studies to identify practice and health system characteristics that influence the process of change in response to the interventions. The proposed study will further understanding of features of primary care practices that affect response to quality improvement interventions, and will inform new strategies to increase preventive service delivery.