Enhancing Colorectal CA Screening through Learning Teams

描述(由申请人提供)：通过学习团队加强结直肠CA筛查背景：初级保健实践可持续接触到大多数美国人口，使其成为早期发现结直肠癌的理想选择。然而，由于其广泛的重点和相互竞争的需求，初级保健实践往往无法将循证筛查战略转化为实践。背景：基于10多年来NCI和AHRQ资助的观察性和干预性研究，我们开发了一个组织变革模型，该模型将实践变革理解为一个复杂和动态的多维过程。我们已将这一模式转化为干预策略，其中包括多方法评估过程(MAP)，以了解不同初级保健实践的独特障碍、机会和复杂性，以及涉及患者、办公室工作人员和医生的反思适应过程(RAP)。参与协作学习增强了动力，扩大了变革的可用选择。这种MAP/RAP学习协作干预的目标既有改变的整体实践能力，也有结直肠癌筛查。目的：本研究评估创新的MAP/RAP干预在初级保健实践中是否提高和维持结直肠癌筛查的比率。方法：将对代表不同患者群体和支付系统的30家初级保健机构进行一组随机临床试验。每个诊所的MAP将确定促进和/或阻碍遵守癌症筛查指南的特征。然后，由临床医生、工作人员和患者组成的RAP团队将实施针对整个实践的量身定制的改进。参与实践学习协作将加强RAP过程，并协助实践确定加强癌症筛查的选择。在基线、12个月和24个月时，将比较干预和控制措施的结直肠癌筛查率。将使用多层建模来控制群集和任何基线差异。比较案例研究过程分析将确定与成功相关的干预措施的特征。这些见解将被纳入控制组的精细化干预(延迟干预)，并在前/后设计中进行评估。意义：这种量身定制的多方面干预极有可能导致在多个实践环境中结直肠癌筛查率的可持续增长。实践的改进将转化为新的努力，在大多数美国人接受大部分医疗保健的环境中增加癌症筛查。

DESCRIPTION (provided by applicant): Enhancing Colorectal CA Screening through Learning Teams Context: Primary care practices have ongoing access to the majority of the U.S. population, making them ideal for the early detection of colorectal cancer. However, due to their broad focus and competing demands, primary care practices often fail to translate evidence-based screening strategies into practice. Background: Based on more than 10 years of NCI and AHRQ funded observational and intervention research, we developed an organizational change model that understands practice change as a complex and dynamic multi-dimensional process. We have translated this model into an intervention strategy that incorporates a multi-method assessment process (MAP) for understanding the unique barriers, opportunities and complexity of diverse primary care practices and a Reflective Adaptive Process (RAP) that involves patients, office staff, and physicians. Participation in learning collaborative enhances motivation and expands available options for change. This MAP/RAP-learning collaborative intervention targets both overall practice capacity to change and colorectal cancer screening. Purpose: This study evaluates whether the innovative MAP/RAP intervention enhances and sustains rates of colorectal cancer screening in primary care practice. Methods: A group randomized clinical trial of 30 primary care practices representing diverse patient populations and payment systems will be conducted. MAP at each practice will identify features that foster and/or impede adherence to cancer screening guidelines. An RAP team of clinicians, staff, and patients will then implement tailored improvements that target the whole practice. Participation in a practice learning collaborative will reinforce the RAP process and assist practices in identifying options for enhancing cancer screening. Rates of colorectal cancer screening will be compared for intervention and control practices at baseline, 12, and 24 months. Multilevel modeling will be used to control for clustering and any baseline differences. A comparative case study process analysis will identify features of the intervention associated with success. These insights will be incorporated into a refined intervention for the control group (delayed intervention), and evaluated in a pre/post design. Significance: This tailored multi-faceted intervention is highly likely to result in sustainable increases in rates of colorectal cancer screening across multiple practice settings. Practice improvements will be translatable into new efforts that increase cancer screening in the settings where the majority of Americans receive most of their medical care.