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。 降低死亡率，并被广泛推荐给所有 50 岁以上的成年人，但超过 35% 的美国人 为了解决 CRC 筛查的多重障碍（患者、临床医生和系统），我们 团队开发了 mPATH-CRC（健康结直肠癌移动患者技术），这是一种患者友好型 mPATH-CRC 是个人在常规初级保健就诊之前立即使用的 iPad 程序。 筛查决策辅助，帮助患者做出筛查决定，允许患者“自助订购”CRC 筛选测试，最大限度地减少提供商和系统障碍。访问后，mPATH-CRC自动发送。 选择接受筛查的患者在关键时刻发送支持性短信，帮助他们完成选择 在我们最近完成的 450 名不同患者的随机对照试验 (R01CA178941) 中，mPATH- CRC 完成 CRC 筛查的患者比例增加了一倍，以充分实现 mPATH-CRC 的目标。 由于该计划有可能降低结直肠癌死亡率，所以现在必须以某种方式在初级保健实践中实施该计划 然而，尽管有数百种移动医疗 (mHealth) 工具已经存在，但仍鼓励日常和持续使用。 近年来制定了实施和维持移动医疗干预措施的最佳策略 我们开发了基于“高接触”的移动医疗实施策略。 基于我们之前的研究并以技术接受模型和动态可持续性为指导 我们的策略利用基于证据的要素，包括诊所倡导者、便利化、定期性。 我们团队现在建议比较“高”的结果。 使用 III 型混合研究设计并结合混合方法，将“接触”策略转变为“低接触”策略 评估 mPATH-CRC 在不同样本中的实施、维护和有效性 该提案的具体目标是： 1) 集群随机控制。 对 28 个初级保健诊所进行的试验，比较“高度接触”循证的实施结果 具有“低接触”实施策略的移动医疗实施策略 2) 在嵌套的前后研究中， 评估 mPATH-CRC 对就诊 16 周内完成 CRC 筛查的影响；以及 3) 确定 通过调查促进或阻碍 mPATH-CRC 等 mHealth 干预措施维持的因素 作为混合方法分析的一部分，采访诊所工作人员和提供者可能会减少该项目。 通过将我们基于证据的结直肠癌筛查干预措施转化为社区来降低结直肠癌发病率和死亡率 实践，直接实现“健康人民 2020”和“国家癌症登月计划”的目标。 完成这些目标将为成功实施其他技术提供必要的信息—— 对初级保健机构进行中介干预，解决当前的知识差距。