Behavioral Economics and Population-based Colorectal Cancer Screening

项目摘要/摘要 这份提案描述了一项为期5年的全面培训计划和指导研究 从事医疗保健服务研究的学术生涯。我是医学和卫生政策的助理教授， 宾夕法尼亚大学。我的目标是成为一名独立的调查员，评估 系统可以利用社会科学的新见解来改善结直肠癌的机会和质量 (CRC)筛查。虽然我在临床胃肠病学和回顾健康方面有很强的背景 在服务研究方面，我将在定性研究方面接受额外的教学和经验培训， 临床试验的方法学问题，以及实施科学。在宾夕法尼亚大学，我会 利用经验丰富的指导团队，与医疗保健提供系统建立密切合作伙伴关系， 和佩雷尔曼医学院在行为经济学和消费者营销方面的专业知识 沃顿商学院。 在美国，CRC是导致癌症死亡的第二大原因。尽管有效的战略是 预防、早期发现和治疗以及积极的公共卫生努力，以促进筛查，国家 费率被限制在62%-65%美国目前主要依靠初级保健提供者来推荐 对那些参加办公室访问的人进行筛查。已经努力创建积极主动和有组织的儿童权利公约 筛查计划，但它们尚未被广泛采用。 我将与宾夕法尼亚大学卫生系统的初级保健服务线合作， 在东部最大的卫生系统内拥有65个不同初级保健实践的学术卫生系统 宾夕法尼亚州和新泽西州。我将进行一个积极主动的过程的迭代试点，以发送结肠镜检查 向符合条件的患者提供准备工具包，以促进参与结直肠癌筛查(目标1)。那么，我会 在1182名符合条件的患者中进行三臂务实随机对照试验，以评估是否有替代方法提供 结肠镜准备试剂盒可提高应答率(目标2)。准备工具包是一种形式的财务 援引互惠规范的激励，将参与定为默认，创造一种捐赠，以及 减轻了患者的工作负担。最后，我将对患者和实践进行定性访谈，以 了解他们在儿童权利公约筛查宣传方面的经验，并制定改进的新办法(目标3)。 这项工作将为我提供技能和初步数据来申请外部资金，以支持 对基于人群的结直肠癌筛查的多层次方法进行务实的试验评估。在此结束时 获奖后，我将接受严谨的研究培训，以补充现有的技能，我将完成一个项目申请 根据行为经济学和消费者营销的原理对CRC进行筛选，我将提交一份有竞争力的 申请R级奖以资助评估国家科学方法实施情况的试验 至结直肠癌筛查外展。

PROJECT SUMMARY/ ABSTRACT This proposal describes a 5-year comprehensive program of training and mentored research for an academic career in health care delivery research. I am an Assistant Professor of Medicine and Health Policy at the University of Pennsylvania. My goal is to become an independent investigator evaluating how health systems can leverage new insights from social science to improve access to and quality of colorectal cancer (CRC) screening. While I have a strong background in clinical gastroenterology and retrospective health services research, I will receive additional didactic and experiential training in qualitative research, methodological issues of clinical trials, and implementation science. At the University of Pennsylvania, I will take advantage of an experienced mentorship team, close partnership with the health care delivery system, and expertise in behavioral economics and consumer marketing across the Perelman School of Medicine and the Wharton School. CRC is the second leading cause of cancer death in the United States. Despite effective strategies for prevention, early detection, and treatment, and aggressive public health efforts to promote screening, national rates are limited at 62-65% The US currently relies predominantly on primary care providers to recommend screening to those who attend an office visit. There have been efforts to create proactive and organized CRC screening programs, but they have not been broadly adopted. I will collaborate with the primary care service line at the University of Pennsylvania Health System, an academic health system with 65 diverse primary care practices within the largest health system in Eastern Pennsylvania and New Jersey. I will conduct an iterative pilot of a proactive process to send colonoscopy preparation kits to eligible patients as a way to facilitate CRC screening participation (Aim 1). Then, I will conduct a 3-arm pragmatic RCT among 1182 eligible patients to evaluate if alternative ways of offering the colonoscopy preparation kit can increase response rates (Aim 2). The preparation kit is a form of a financial incentive that invokes norms of reciprocity, frames participation as the default, creates an endowment, and reduces the burden of patient effort. Finally, I will perform qualitative interviews with patients and practices to understand their experience with CRC screening outreach and develop refined and new approaches (Aim 3). This work will provide me with skills and preliminary data to apply for external funding to support a pragmatic trial evaluating a multi-level approach to population-based CRC screening. At the conclusion of this award, I will receive rigorous research training to complement existing skills, I will complete a project applying principles of behavioral economics and consumer marketing to CRC screening, and I will submit a competitive application for an R-level award to fund a trial evaluating the implementation of a state-of-the-science approach to CRC screening outreach.