Effectiveness and Implementation of mPATH-CRC: a Mobile Health System for Colorectal Cancer Screening

mPATH-CRC 的有效性和实施：用于结直肠癌筛查的移动医疗系统

• 批准号: 10116309
• 负责人: David P Miller
• 金额: $ 44.77万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10116309
• 关键词: Address; Administrator; Adoption; Adult; Age; American; Awareness; Cancer Etiology; Caring; Cessation of life; Charge; Clinic; Colorectal Cancer; Communities; Community Practice; Complex; Data; Decision Aid; Dose; Effectiveness; Elements; Failure; Feedback; Focus Groups; Funding; Future; Geography; Goals; Health; Health Technology; Health system; Healthy People 2020; Hybrids; Individual; Internet; Intervention; Interview; Knowledge; Life; Maintenance; Malignant Neoplasms; Mediating; Medical; Methods; Modeling; Morbidity - disease rate; Patients; Primary Health Care; Procedures; Process; Provider; Randomized Controlled Trials; Research; Research Design; Rural; Sampling; Savings; Schedule; Screening for cancer; Self Efficacy; Site; Speed; Structure; Surveys; System; Technology; Testing; Text Messaging; Time; Touch sensation; Training; Translating; United States; Visit; base; clinical practice; cohort; colorectal cancer screening; community based practice; cost estimate; design; disadvantaged population; dissemination trial; effectiveness analysis; evidence base; follow-up; health care settings; health disparity; implementation cost; implementation measures; implementation outcomes; implementation strategy; implementation study; implementation trial; improved; innovation; mHealth; mortality; patient population; primary care setting; programs; provider factors; response; screening; secondary analysis; secondary outcome; socioeconomic disadvantage; suburb; sustainability framework; theories; tool; uptake

Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Screening for CRC reduces mortality and is widely recommended for all adults starting at age 50, yet over 35% of Americans remain unscreened. To address the multiple barriers to CRC screening (patient, clinician, and system), our team developed mPATH-CRC (mobile PAtient Technology for Health-Colorectal Cancer), a patient-friendly iPad program used by individuals immediately before a routine primary care visit. mPATH-CRC is a CRC screening decision aid that helps patients make a screening decision, allows patients to “self-order” a CRC screening test, and minimizes provider and system barriers. After the visit, mPATH-CRC automatically sends patients who choose to be screened supportive text messages at key times to help them complete their chosen test. In our recently completed randomized controlled trial of 450 diverse patients (R01CA178941), mPATH- CRC doubled the proportion of patients who completed CRC screening. To fully realize mPATH-CRC's potential to decrease CRC mortality, the program now must be implemented in primary care practices in a way that encourages routine and sustained use. However, while hundreds of mobile health (mHealth) tools have been developed in recent years, the optimal strategies for implementing and maintaining mHealth interventions in clinical practice are unknown. We have developed a “high touch” mHealth implementation strategy based on our prior research and guided by the Technology Acceptance Model and the Dynamic Sustainability Framework. Our strategy leverages evidence-based elements including clinic champions, facilitation, regular data feedback, follow-up training, and adaptation. Our team now proposes to compare the results of the “high touch” strategy to a “low touch” strategy using a Type III hybrid study design and incorporating mixed methods to evaluate implementation, maintenance, and effectiveness of mPATH-CRC in a diverse sample of community-based practices. The Specific Aims of the proposal are to: 1) in a cluster-randomized controlled trial of 28 primary care clinics, compare the implementation outcomes of a “high touch” evidence-based mHealth implementation strategy with a “low touch” implementation strategy; 2) in a nested pre-post study, estimate the effect of mPATH-CRC on completion of CRC screening within 16 weeks of visit; and 3) determine the factors that facilitate or impede the maintenance of mHealth interventions like mPATH-CRC by surveying and interviewing clinic staff and providers as part of a mixed-methods analysis. This project could decrease CRC morbidity and mortality by translating our evidence-based CRC-screening intervention into community practice, directly addressing the goals of Healthy People 2020 and the National Cancer Moonshot. Importantly, completion of these aims will yield essential information for successful implementation of other technology- mediated interventions in primary care settings, addressing a current gap in knowledge.

结直肠癌（CRC）是美国癌症死亡的第二大原因。筛选CRC 降低死亡率，并广泛建议所有成年人从50岁开始，但超过35％的美国人 保持未能。为了解决CRC筛查（患者，临床和系统）的多个障碍，我们 团队开发了MPATH-CRC（用于健康色直肠癌的移动患者技术），这是一种患者友好的 在常规初级保健访问之前，个人立即使用的iPad程序。 mpath-crc是CRC 筛查决策辅助援助，以帮助患者做出筛查决策，允许患者“自我顺序” CRC 筛选测试，并最大程度地减少提供商和系统障碍。访问后，MPATH-CRC自动发送 选择在关键时间筛选支持的短信的患者，以帮助他们完成选择 测试。在我们最近完成的450名潜水员患者（R01CA178941）的随机对照试验中 CRC使完成CRC筛查的患者比例增加了一倍。完全实现Math-Crc的 潜力降低CRC死亡率，现在必须以某种方式在初级保健实践中实施该计划 这鼓励了常规和持续使用。但是，尽管数百种移动健康（MHealth）工具具有 近年来是开发的，是实施和维护MHealth干预措施的最佳策略 在临床实践中是未知的。我们已经开发了基于“高触摸” MHealth实施策略 在我们先前的研究中，并受到技术接受模型和动态可持续性的指导 框架。我们的战略利用循证要素，包括诊所冠军，设施，常规 数据反馈，后续培训和适应。我们的团队现在提出比较“高 使用III型混合研究设计的“低触摸”策略的触摸策略，并结合了混合方法 评估MPATH-CRC在潜水员样本中的实施，维护和有效性 基于社区的实践。该提案的具体目的是：1）在群集随机受控中 28个初级保健诊所的试验，比较“高触摸”基于证据的实施结果 MHealth实施策略具有“低触摸”实施策略； 2）在一项嵌套前研究中， 估计MPATH-CRC在访问后16周内完成CRC筛查的影响； 3）确定 通过调查来促进或阻碍MHealth干预措施（例如MPATH-CRC）维护的因素 作为混合方法分析的一部分，采访诊所工作人员和提供者。这个项目可能会减少 CRC的发病率和死亡率通过将我们的循证CRC筛查干预转化为社区 练习，直接解决2020年健康人的目标和国家癌症月球的目标。重要的是， 这些目标的完成将获得成功实施其他技术的基本信息 - 在初级保健环境中进行了介导的干预措施，以解决当前知识的差距。