COLORECTAL CANCER SCREENING IN PRIMARY CARE PRACTICE

描述（由申请人提供）： 结直肠癌（CRC）是美国癌症死亡的第二大原因，早期发现和治疗疾病和前驱病变可以预防许多死亡。然而，大多数美国成年人没有接受过CRC筛查，而改善CRC筛查是国家健康人2010目标的一个组成部分。实践伙伴研究网络（PPRNet）是一个基于实践的研究网络，在33个州使用通用电子病历（EMR）的初级卫生保健提供者中开展工作，已经开发出一种质量改进模型，用于成功地将心血管研究转化为初级保健实践，称为PPRNet-TRIP。PPRNet-TRIP结合了基于证据的质量哲学的优先级，涉及所有工作人员（团队合作），输送系统重新设计，患者激活，以及个性化和基于人群的医学EMR工具。PPRNet-TRIP通过实践绩效报告、实践现场访问、网络会议和基于网络的工具相结合的方式在实践环境中实施。申请中提出的活动的目的是通过在30个初级保健实践中进行的随机对照临床试验评估PPRNet-TRIP是否也可以改善提供者的建议和患者接受CRC筛查。该项目为期4年，干预期为两年。15个实践将被随机分配到一个控制组和15个干预组。对照组实践将接受CRC筛查指南。干预组的做法将收到CRC筛查绩效报告，并参加每年两次的实践现场访问和年度研究会议，以帮助他们采用PPRNet-TRIP改进模型进行CRC筛查。两年后，将评估干预对CRC筛查建议和完成的影响。还将进行混合方法过程评价，以评估参与实践中PPRNet-TRIP的采用情况。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second leading cause of cancer death in the United States and early detection and treatment of the illness and precursor lesions can prevent many of these deaths. Yet a majority of American adults have not received CRC screening, and improved CRC screening is one component of the nation's Healthy People 2010 goals. The Practice Partner Research Network (PPRNet), a practice-based research network among primary health care providers practicing in 33 States who use a common electronic medical record (EMR), has developed a quality improvement model for successfully translating cardiovascular research into primary care practice termed PPRNet-TRIP. PPRNet-TRIP incorporates prioritization of evidence-based quality philosophies, involving all staff (teamwork), delivery system redesign, patient activation, and EMR tools for individualized and population-based medicine. PPRNet-TRIP is implemented in practice settings through a combination of practice performance reports, practice site visits, network meetings, and web-based tools. The purpose of the activities proposed in the application is to assess, through a randomized controlled clinical trial in 30 primary care practices whether PPRNet-TRIP can also improve provider recommendation and patient receipt of CRC screening. The project will be 4 years in duration, with a two-year intervention. Fifteen practices will be randomly allocated to a control group and 15 to an intervention group. Control group practices will receive CRC screening guidelines. Intervention group practices will receive CRC screening performance reports and participate in twice-yearly practice site visits and annual research meetings to help them adopt the PPRNet-TRIP improvement model for CRC screening. After two years the impact of the intervention on CRC screening recommendation and completion will be assessed. A mixed-method process evaluation will also be conducted to assess the adoption of PPRNet-TRIP within participating practices.