Implementing Systemic Interventions to Close the Discovery-Delivery Gap

描述（由申请人提供）：美国国立卫生研究院和其他联邦机构将基于提供者的研究网络（pbrn）视为在社区实践环境中传播和实施循证临床服务的有前途的模式。pbrn是社区提供者和学术机构之间的合作伙伴关系，旨在持续开展临床研究。国家卫生研究院正在调查培训5万名社区保健从业人员参与临床研究并将新的研究成果纳入日常保健服务的可行性，这是其对社区保健护士承诺的一项指标。然而，报告表明，野生动物保护区在实施和维持方面具有挑战性。此外，pbrn在多大程度上实际上促进了以社区为基础的临床服务的使用，这在很大程度上仍然是未知的。该项目将研究NCI社区临床肿瘤学项目（CCOP）的实施、影响、可持续性和商业案例。CCOP是一个由联邦政府资助的国家PBRN， NIH将其视为其他疾病领域PBRN的典范。具体而言，该项目将(1)通过对3个新资助的CCOP组织的深入案例研究和对所有50个CCOP组织的调查，调查CCOP在社区实践环境中的实施情况；(2)利用SEER-Medicare数据，通过对CCOP附属机构和非CCOP附属机构对循证癌症治疗的采用率进行纵向分析，检验CCOP对临床实践的影响；(3)通过对1991 - 2003年在社区实践环境中开展活动的所有CCOP组织的纵向分析，评估影响CCOP可持续性的因素；(4)通过分析财务和统计数据以及深入的案例研究，调查供应商参与CCOP的商业案例。该项目将为NIH提供急需的信息，了解如何实施和维持pbrn，以及如何将pbrn作为在社区实践环境中传播和实施循证临床服务的模式。

DESCRIPTION (provided by applicant): The NIH and other federal agencies see provider-based research networks (PBRNs) as a promising model for disseminating and implementing evidence-based clinical services in community-based practice settings. PBRNs are collaborative partnerships between community-based providers and academic institutions to conduct clinical research on an ongoing basis. As an indicator of its commitment to PBRNs, the NIH is investigating the feasibility of training 50,000 community-based health-care practitioners to participate in clinical research and integrate new research findings into routine health care delivery. Yet, reports indicate that PBRNs are challenging to implement and sustain. Further, the extent to which PBRNs actually promote the use of evidence-based clinical services in community-based practice settings remains largely unknown. This project will examine the implementation, impact, sustainability, and business case of the NCI's Community Clinical Oncology Program (CCOP), a federally funded national PBRN that the NIH sees as a model for PBRNs in other disease areas. Specifically, the project will (1) investigate the implementation of the CCOP in community-based practice settings through in-depth case studies of three newly funded CCOP organizations and a survey of all 50 CCOP organizations; (2) examine the impact of the CCOP on clinical practice through longitudinal analysis of adoption rates of evidence-based cancer therapies by CCOP- affiliated and non-CCOP-affiliated providers using SEER-Medicare data; (3) assess the factors affecting sustainability of the CCOP in community-based practice settings through a longitudinal analysis of all CCOP organizations active from 1991 through 2003; and (4) investigate the business case for CCOP participation by providers through analysis of financial and statistical data and in-depth case studies. The project will provide the NIH with much-needed information about what it takes to implement and sustain PBRNs and what it can expect from PBRNs as a model for disseminating and implementing evidence-based clinical services in community-based practice settings.