Implementing Cancer Prevention Using Patient - Provider Clinical Decision Support

利用患者 - 提供者临床决策支持实施癌症预防

基本信息

批准号：
9248997
负责人：
THOMAS EDWARD ELLIOTT
金额：
$ 61.9万
依托单位：
HEALTHPARTNERS INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-03-24 至 2021-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9248997
关键词：
Address Adolescent Adult Advisory Committees Algorithms Breast Cancer Detection Cancer Burden Cancer Prevention Intervention Caring Centers for Disease Control and Prevention (U.S.)Cervical Cancer Screening Cessation of life Clinic Clinical Clinical Decision Support Systems Cluster randomized trial Colorectal Cancer Cost Analysis Data Decision Support Systems Disadvantaged Effectiveness Electronic Health Record Eligibility Determination Evidence based treatment Female Future Goals Health Care Costs Health system Healthcare Healthcare Systems Healthy People 2020 Human Papilloma Virus Vaccination Immunization Impact evaluation Intervention Lead Link Malignant Neoplasms Malignant neoplasm of cervix uteri Medical Medically Underserved Area Methods Modeling Morbidity - disease rate Online Systems Outcome Patient Care Patients Prevention strategy Preventive Preventive Intervention Preventive care Preventive service Primary Cancer Prevention Primary Health Care Primary Prevention Process Provider Quality of life Randomized Recommendation Research Research Methodology Risk Risk Factors Rural Rural Population Screening for cancer Second Primary Cancers Secondary Cancer Prevention Secondary Prevention Secure Services Study Subject System Testing Time United States Visit Weight maintenance regimen Woman Work aged arm burden of illness cancer prevention cancer type clinical risk colorectal cancer screening cost cost effectiveness demographics design disorder prevention dissemination research evidence base follow-up health care disparity health disparity implementation research implementation science improved indexing male malignant breast neoplasm member mortality patient oriented personalized decision point of care post intervention prevent prevention service primary care setting public health relevance research data dissemination rural area rural healthcare rural setting screening sex smoking cessation three-arm study tool treatment as usual urban area web site

项目摘要

DESCRIPTION (provided by applicant): Millions of U.S. adults and adolescents do not receive key evidence-based preventive care services. Rural populations are especially disadvantaged with multiple healthcare disparities, resulting in lower rates of primary and secondary cancer prevention interventions. The objective of this project is to implement and evaluate the effectiveness of a sophisticated Web-based, electronic health record (EHR)-linked clinical decision support (CDS) system designed to improve primary and secondary cancer preventive care. To achieve this objective, we link EHR data to evidence-based cancer prevention algorithms in a secure Web site to: (a) identify at the point of care all eligible patients not up o date on their cancer prevention interventions; and (b) present to both patient and primary care provider (PCP) and/or a key member of the primary care team, certified medical assistant (CMA), appropriate evidence-based primary cancer prevention interventions and cancer screening options at the point of care. The Cancer Prevention-CDS will focus on breast cancer screening in women aged 50-74, colorectal cancer screening for both sexes aged 50-75, cervical cancer screening for women aged 21-65, human papilloma virus (HPV) vaccination for both sexes aged 11-26, and referrals for weight management and smoking cessation in all adults aged 18 and older. Effectiveness is assessed by cluster-randomizing 30 primary care clinics with roughly 285 PCPs and 153,000 study-eligible patients into one of three experimental conditions: Group 1: PCP-focused CDS intervention in which the PCP triggers use of the CDS system and engages patients in appropriate cancer prevention strategies. Group 2: CMA-focused CDS intervention in which the CMA triggers use of the CDS system and interacts with the patient to engage them in appropriate cancer prevention strategies before seeing their PCP, who will approve or discuss the plan with their patient. Group 3 clinics provide usual care with no intervention-related activity related to cancer prevention. With 10 clinics, 95 PCPs, and 51,000 potentially eligible patients per study arm, this study will formally test the hypothesis tht Groups 1 and 2 are superior to Group 3 over an 18-month follow-up period with respect to: (a) significantly higher rates of appropriate screening for breast, cervix, and colorectal cancer, as defined by the United States Preventive Services Task Force; and (b) significantly higher rates of human papillomavirus (HPV) vaccination in males and females aged 11-26 years. We further posit that Groups 1 and 2 will have higher short-term health care costs but better long-term cost-effectiveness than Group 3. The Consolidated Framework for Implementation Research (CFIR) and RE-AIM conceptual frameworks will be used to guide implementation planning, organization, conduct, and impact evaluation of the intervention in a large rural healthcare system. This project will engage a rural population with substantial healthcare disparities and gaps in the receipt of primary and secondary cancer prevention. Results will advance dissemination and implementation research methods that can reduce health disparities and improve healthcare for millions in medically underserved areas.

描述（由适用提供）：数以百万计的美国成年人和青少年没有获得基于证据的预防保健服务。农村人口尤其受到多种医疗保健差异的困扰，导致预防癌症和继发性预防措施较低。该项目的目的是实施和评估基于网络的高级电子健康记录（EHR）连接的临床决策支持（CDS）系统的有效性，旨在改善初级和继发性预防性护理。为了实现这一目标，我们将EHR数据与安全网站中的基于证据的癌症预防算法联系起来：（a）在护理点确定所有合格的患者在预防癌症预防干预措施上都不适合日期；（b）向患者和初级保健提供者（PCP）和/或初级保健团队，认证医疗助理（CMA），适当的基于证据的初级癌症预防干预措施和癌症筛查方案的主要成员。癌症预防CD将专注于50-74岁女性的乳腺癌筛查，50-75岁的男女筛查，对21-65岁妇女的宫颈癌筛查，人类乳头状瘤病毒（HPV）疫苗（HPV）疫苗为11-26岁的男女疫苗，以及用于体重管理和吸烟蛋白质的成年成年人的转介。通过将30个初级保健诊所群集成，大约285个PCP和153,000名符合研究资格的患者来评估有效性：第1组：以PCP为中心的CDS干预措施，PCP触发了CDS系统的使用，并使患者参与适当的癌症预防策略。第2组：以CMA为重点的CDS干预措施，其中CMA触发者使用CDS系统并与患者进行互动，以在看到其PCP之前与他们进行适当的预防癌症预防策略，后者将批准或与患者讨论该计划。第3组诊所提供常规护理，没有与预防癌症有关的干预相关活动。在每个研究部门的10个诊所，95个PCP和51,000名潜在符合条件的患者中，本研究将正式检验1组和第2组的假设在18个月的随访期内，相对于：（a）相对于：（a）乳腺癌，宫颈和有色癌症的适当筛查率明显较高，如美国预防服务癌症所定义的那样；（b）男性和11-26岁的男性和女性的人乳头瘤病毒（HPV）疫苗接种率明显更高。我们进一步赞赏，第1组和第2组的短期医疗保健成本将比第3组更高，但长期成本效益更好。实施研究的合并框架（CFIR）和RE-AIM概念框架将用于指导实施计划，组织，行为，行为，行为和影响大型农村医疗系统中干预的评估。该项目将使农村人口具有巨大的医疗保健差异和差距，以收到预防初级和继发性癌症。结果将推动传播和实施研究方法，这些方法可以减少健康差异并改善医疗服务不足的地区数百万的医疗保健。