Grant Details
Grant Number: |
3R01CA060862-06S1 Interpret this number |
Primary Investigator: |
Stange, Kurt |
Organization: |
Case Western Reserve University |
Project Title: |
Direct Observation of Primary Care-CA Prevention Trial |
Fiscal Year: |
2000 |
Abstract
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.
Publications
None. See parent grant details.