DIRECT OBSERVATION OF PRIMARY CARE--CA PREVENTION TRIAL

说明：申请人认为本申请是第三个 为增加初级教育预防服务而采取的代人干预措施 在乎 他们记录了缺乏遵守预防准则的情况。 医生往往高估他们提供的预防服务。 单一干预，如提醒、审计和反馈，以及患者持有 迷你唱片可以改变练习行为。 二代 干预措施提供了灵活性，允许个别医生和 选择具体的干预措施。 第三代干预 从有效的单一干预措施菜单中提供选择， 他们的个人需要和实践的特点。 具体目标是：1）评估这种干预对 为合资格病人提供预防癌症服务的水平; 2） 评估干预措施对提供其他 服务、执业环境、患者、医生和办公室; 3） 评估协变量对干预效果的影响;以及4） 描述和评估医生和实践的变化过程 行为 有16个主要假设与这些具体目标有关。 的 应用程序为这些假设中的每一个提供了理由。 在 在分析部分，概述了每个假设的分析策略。 样本将是参与先前研究的138名医生。 干预措施将是由一名医生对每个诊所进行四次定期访问， 护士-协调员，电话随访。 护士-促进者 将首先进行一次情况介绍访问。 两周后， 专注于准备实践，以实施必要的变革， 增加预防方式的利用。 这些将被选中 从菜单上。 每个实践将指定一个实践团队负责人， 作为研究的主要联系人。 在第三次访问中， 护士-促进者将提供个性化的干预材料， 已经为实践做好了准备。 这将在一周内发生， 到实施日期。 每月将有几个电话打给 与实践领导讨论实施过程中存在的问题。 的 最后一次访视将在干预开始后7个月进行。 这将是在联合国儿童基金会进行为期六个月的成果评估一个月后举行的。 研究助理。 将从结局评估中获得数据， 为实践提供反馈，并允许有机会微调 干预

DESCRIPTION: The applicants consider this application to be a third generation intervention for increasing the delivery of prevention in primary care. They document the lack of adherence to prevention guidelines. Physicians tend to overestimate their delivery of prevention services. Single interventions such as reminders, audit and feedback, and patient-held mini-records can make changes in practice behavior. Second generation interventions provide flexibility by allowing individual physicians and practices to choose specific interventions. A third generation intervention offers choices from a menu of effective single interventions, and tailors them to the individual needs and characteristics of the practice. The Specific Aims are to: 1) evaluate the effect of this intervention on the level of cancer preventive service delivery to eligible patients; 2) evaluate the ancillary effects of the interventions on delivery of other services, the practice environment, patients, physicians and office; 3) evaluate the effect of co-variates on the effect of the intervention; and 4) describe and evaluate the process of change in physician and practice behavior. There are 16 major hypotheses associated with these Specific Aims. The application provides a rationale for each of these hypotheses. In the analysis section, an analysis strategy is outlined for each the hypotheses. The sample will be 138 physicians who participated in the previous study. The intervention will be four scheduled visits to each practice by a nurse-facilitator with follow-up telephone calls. The nurse-facilitator will first conduct an orientation visit. Two weeks later the visit will focus on preparing the practice to implement the changes necessary to increase the utilization of prevention modalities. These will be chosen from a menu. Each practice will assign a practice team leader, who will serve as the main contact to the study. On the third visit, the nurse-facilitator will deliver the personalized intervention materials that have been prepared for the practice. This will occur within one week prior to the implementation date. Several monthly phone calls will be made to the practice leader to discuss problems with the implementation process. The last visit will occur seven months after the initiation of the intervention. This will be one month after the six-month outcome assessment by the research assistant. Data will be available from the outcome assessment to provide feedback to the practice and allow an opportunity to fine tune the intervention.