A multi-modal, physician-centered intervention to improve guideline-concordant prostate cancer imaging

以医生为中心的多模式干预措施，以改善符合指南的前列腺癌成像

• 批准号: 9663813
• 负责人: DANIL V. MAKAROV
• 金额: --
• 依托单位: VA NEW YORK HARBOR HLTHCARE/SYS/BROOKLYN
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9663813
• 关键词: Academic Detailing; Address; Affect; Agreement; Behavior; Behavior Therapy; Caring; Clinical; Cluster randomized trial; Communication Methods; Data; Data Collection; Diagnostic radiologic examination; Effectiveness; Feedback; Fright; Geographic Locations; Geography; Goals; Guidelines; Healthcare Systems; Image; Individual; Integrated Delivery of Health Care; Intervention; Interview; Intuition; Knowledge; Legal; Malignant Neoplasms; Malignant neoplasm of prostate; Medical; Medical Care Costs; Methods; Newly Diagnosed; Newly Diagnosed Disease; Operative Surgical Procedures; PSA screening; Patients; Perception; Physicians; Population; Preparation; Provider; Publishing; Reporting; Research; Residencies; Resources; Risk; Savings; Self Efficacy; Site; Societies; Staging; Structure; Surgeon; System; Time; Training; Trust; Variant; Veterans; Work; academic program; base; behavior change; cancer care; cancer imaging; clinical research site; cost; design; evidence base; experience; health care delivery; high risk men; improved; intervention cost; intervention effect; medical specialties; men; multimodality; novel; peer; prostate cancer risk; theories

Background: Almost half of Veterans with localized prostate cancer (the most common non-cutaneous malignancy among US men) receive inappropriate, wasteful imaging. The VHA Blueprint for Excellence prioritizes increasing operational effectiveness. Prior studies seeking to limit inappropriate imaging did not assess barriers and achieved mixed results. Our team has explored the causes of guideline-discordant prostate cancer imaging and found that 1) patients with newly diagnosed prostate cancer have little concern for radiographic staging but rather focus on treatment, 2) physician trust imaging guidelines but are apt to follow their own intuition, fear medico-legal consequences, and succumb to influence from colleagues who image frequently. In spite of such discrepant v iews, most VHA physicians suggested or supported a large-scale effort to improve imaging use across VHA. Intervention: We propose a multi-site, stepped wedge, cluster-randomized trial to determine the effect of a physician-focused behavioral intervention on VHA prostate cancer imaging use. The multi-level intervention, developed according to the Theoretical Determinants Framework, combines traditional physician behavior change methods with novel methods of communication and data collection. The intervention consists of three components: 1) a system of audit and feedback to clinicians informing individual clinicians and their sites about how their behavior compares to their peers’ and to published guidelines 2) a program of academic detailing with the goal to educate providers about prostate cancer imaging, and 3) a CPRS Clinical Order Check for potentially inappropriate imaging. The intervention will be introduced to 10 participating geographically-distributed study sites. Analysis Plan: We will assess imaging rates 6 months prior to the intervention and 3 months following the intervention. The study’s specific aims seek to understand the effects of the intervention on 1) facility-level prostate cancer imaging rates, 2) physician experience with and perceptions of the intervention and its implementation, and 3) the costs of both implementing the intervention and affecting change in imaging use. These aims will support a subsequent intervention to improve guideline-concordant imaging across VHA. Experience gained through this project will be leveraged to improve guideline-concordant care and increase operational effectiveness in other domains. Importance: This project seeks to describe and analyze the implementation of a behavioral intervention to improve prostate cancer care. This theory-based intervention builds on prior work identifying barriers to guideline-concordant prostate cancer imaging in VHA (CDA 11-257) and addresses these at three levels: individual (audit and feedback with VHA Cancer Care Cube data), facility (academic detailing) and system (CPRS Order Check). The team will assess the intervention’s cost impact and providers’ experiences in preparation for a subsequent large -scale VHA implementation project optimizing the operational effectiveness of prostate cancer imaging across VHA. The current application is an opportunity to leverage VHA’s state-of-the-art, integrated healthcare delivery system to implement a carefully designed, theory-based behavioral intervention to reduce harmful, inappropriate care, increase appropriate care to those who truly need it, and simultaneously save money for the healthcare system.

背景：几乎一半的患有局部前列腺癌的退伍军人（最常见的非乳头 我们中的恶性肿瘤）获得不适当，浪费的成像。 VHA蓝图卓越 优先考虑提高操作效率。试图限制不适当成像的先前研究未评估 障碍并取得了不同的结果。我们的团队探索了指南诊断前列腺癌的原因 成像并发现1）新诊断的前列腺癌患者对射线照相很少关注 分阶段而不是专注于治疗，2）物理信任成像指南，但易于遵循自己的直觉， 害怕医疗法律后果，并屈服于经常形象的同事的影响。尽管 这样的差异v iews，大多数VHA医生建议或支持大规模的努力来改善成像使用 穿过VHA。 干预：我们提出了一个多站点，阶梯楔形的，聚类随机试验，以确定A的效果 对VHA前列腺癌成像使用的物理行为干预。多层次干预， 根据理论决定因素框架开发的，结合了传统的身体行为 通过新颖的通信和数据收集方法更改方法。干预措施包括三个 组件：1）向临床医生通知各个临床医生及其网站的审计和反馈系统 他们的行为与同龄人的行为比较和发布指南2） 教育提供者有关前列腺癌成像的目标，以及3）CPRS临床订单检查是否有可能 不适当的成像。该干预措施将引入10项参与地理分布的研究 站点。 分析计划：我们将在干预前6个月和3个月后评估成像率 干涉。该研究的具体目的旨在了解干预对1）设施级别的影响 前列腺癌成像率，2）对干预及其的身体经验及其感知 实施，以及3）实施干预和影响成像使用变化的成本。 这些目标将支持随后的干预措施，以改善VHA的指南符合成像。 通过该项目获得的经验将被利用以提高指导原则，并增加 其他领域的操作有效性。 重要性：该项目旨在描述和分析行为干预的实施 改善前列腺癌护理。这种基于理论的干预措施是基于先前的工作确定障碍的 VHA（CDA 11-257）中的指南符合前列腺癌成像，并在三个层面上解决了这些成像： 个人（使用VHA Cancer Care Cube数据的审核和反馈），设施（学术细节）和系统（CPRS 订购检查）。团队将评估干预的成本影响以及提供者的经验，以准备 随后的大型VHA实施项目优化了前列腺癌的运营有效性 跨VHA成像。当前的申请是利用VHA最先进的整合的机会 医疗保健提供系统，以实施精心设计的基于理论的行为干预措施，以减少 有害，不恰当的护理，增加对真正需要它的人的适当护理，只是节省金钱 用于医疗保健系统。