Pragmatic Implementation Science Approaches to Assess and Enhance Value of Cancer Prevention and Control in Rural Primary Care

项目摘要/摘要-行政核心我们拟设立的实施科学中心的主题是“以务实的实施科学方法评估和提升农村初级保健癌症防治的价值”。我们将应用和推进与成本、效益和价值相关的框架、务实的方法和措施，这些框架、方法和措施严格，但也可以推广到农村初级保健机构，这些机构往往面临资源不足和高需求人口的困境。这些模型和方法将用于指导癌症预防和控制（CPC）循证项目的选择和实施。我们将首先关注农村初级保健机构的肺癌筛查，首先在科罗拉多州，然后通过与一个完善的初级保健网络（即国家研究网络）合作，在全国范围内开展。我们的总体框架将是我们增强的RE-AIM/PRISM模型，它是广泛使用的范围、有效性、采用、实施和维护框架的扩展，并增加了上下文因素（例如，干预特征、实施和可持续性基础设施）。它将作为从不同利益相关者的角度开发和测试成本、收益和价值的创新评估的基础，以理解和指导实施。在我们所有的研究中，我们将有意义地参与并纳入患者、提供者和员工利益相关者的观点。我们的试点实施研究将采用利益相关者参与的价值方法来调整、实施和评估战略，以指导实施与肺癌筛查相关的共同决策和戒烟。我们的方法组将完善和评估我们实用的成本评估方法，从患者、提供者和交付人员的角度确定实施/复制成本，然后开发和试点测试关于不同RE-AIM结果相对收益偏好的简短调查措施。然后，我们将评估RE-AIM结果偏好与不同CPC方案选择之间的关系。最后，我们的外联和网络部门将参与a)针对初级和中期职业调查人员和从业人员的外联活动，包括在线专业发展（例如，研究生证书课程，微认证）以及量身定制的指导和技术援助方法；B)支持包装和传播研究成果的传播活动；c)开展合作活动，通过多种渠道促进CPC伙伴关系和实施科学，包括开发共享的务实D&I措施和数据。

Project Summary/Abstract – Administrative Core The theme of our proposed Implementation Science Center is “Pragmatic implementation science approaches to assess and enhance the value of cancer prevention and control in rural primary care.” We will apply and advance frameworks, pragmatic methods, and measures related to cost, benefits, and value that are rigorous, but also generalizable across rural primary care settings that are often struggling with low resources, and a high need population. These models and methods will be used to guide selection and implementation of evidence-based programs for cancer prevention and control (CPC). We will initially focus on lung cancer screening in rural primary care settings, first in Colorado and then nationally through collaboration with a well- established primary care network (i.e., National Research Network). Our overarching framework will be our enhanced RE-AIM/PRISM model, which is an extension of the broadly used Reach, Effectiveness, Adoption, Implementation, and Maintenance framework with the addition of contextual factors (e.g., Intervention characteristics, implementation and sustainability infrastructure). It will serve as the basis to develop and test innovative assessments of costs, benefits, and value from the perspective of different stakeholders to understand and guide implementation. We will meaningfully engage with and include the perspectives of patients, providers, and staff stakeholders in all our studies. Our pilot Implementation Study will adapt, implement, and evaluate strategies using stakeholder-engaged approaches to value to guide the implementation of shared decision-making and smoking cessation related to lung cancer screening. Our Methods Unit will refine and evaluate our pragmatic cost assessment methods to determine implementation/replication costs from the perspective(s) of patients, providers, and delivery staff and then develop and pilot test brief survey measures of preferences regarding the relative benefit of different RE-AIM outcomes. We will then assess relationships among RE-AIM outcomes preferences and selection of different CPC programs. Finally, our Outreach and Network Unit will engage in a) outreach activities targeted at junior and mid-career investigators and practitioners including online professional development (e.g., graduate certificate program, micro-certification) and tailored mentoring and technical assistance approaches; b) dissemination activities to support the packaging and communication of research findings; and c) collaboration activities to facilitate partnerships on CPC and implementation science using multiple channels and including development of shared pragmatic D&I measures and data.