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Grant Details

Grant Number: 5R01CA193396-05 Interpret this number
Primary Investigator: Elliott, Thomas
Organization: Healthpartners Institute
Project Title: Implementing Cancer Prevention Using Patient - Provider Clinical Decision Support
Fiscal Year: 2020


 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.


Human Papillomavirus vaccination clinical decision support for young adults in an upper midwestern healthcare system: a clinic cluster-randomized control trial.
Authors: Harry M.L. , Asche S.E. , Freitag L.A. , Sperl-Hillen J.M. , Saman D.M. , Ekstrom H.L. , Chrenka E.A. , Truitt A.R. , Allen C.I. , O'Connor P.J. , et al. .
Source: Human vaccines & immunotherapeutics, 2022-12-31; 18(1), p. 2040933.
EPub date: 2022-03-18.
PMID: 35302909
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Clinical Decision Support with or without Shared Decision Making to Improve Preventive Cancer Care: A Cluster-Randomized Trial.
Authors: Elliott T.E. , Asche S.E. , O'Connor P.J. , Dehmer S.P. , Ekstrom H.L. , Truitt A.R. , Chrenka E.A. , Harry M.L. , Saman D.M. , Allen C.I. , et al. .
Source: Medical decision making : an international journal of the Society for Medical Decision Making, 2022 Aug; 42(6), p. 808-821.
EPub date: 2022-02-25.
PMID: 35209775
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Primary care clinicians' opinions before and after implementation of cancer screening and prevention clinical decision support in a clinic cluster-randomized control trial: a survey research study.
Authors: Harry M.L. , Chrenka E.A. , Freitag L.A. , Saman D.M. , Allen C.I. , Asche S.E. , Truitt A.R. , Ekstrom H.L. , O'Connor P.J. , Sperl-Hillen J.A.M. , et al. .
Source: BMC health services research, 2022-01-06; 22(1), p. 38.
EPub date: 2022-01-06.
PMID: 34991570
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Patient Perceptions of Using Clinical Decision Support for Cancer Screening and Prevention: "I wouldn't have thought about getting screened without it.".
Authors: Saman D.M. , Harry M.L. , Freitag L.A. , Allen C.I. , O'Connor P.J. , Sperl-Hillen J.M. , Bianco J.A. , Truitt A.R. , Ekstrom H.L. , Elliott T.E. .
Source: Journal of patient-centered research and reviews, 2021 Fall; 8(4), p. 297-306.
EPub date: 2021-10-18.
PMID: 34722797
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The impact of personalized clinical decision support on primary care patients' views of cancer prevention and screening: a cross-sectional survey.
Authors: Saman D.M. , Chrenka E.A. , Harry M.L. , Allen C.I. , Freitag L.A. , Asche S.E. , Truitt A.R. , Ekstrom H.L. , O'Connor P.J. , Sperl-Hillen J.M. , et al. .
Source: BMC health services research, 2021-06-21; 21(1), p. 592.
EPub date: 2021-06-21.
PMID: 34154588
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Design and rationale of an intervention to improve cancer prevention using clinical decision support and shared decision making: A clinic-randomized trial.
Authors: Elliott T.E. , O'Connor P.J. , Asche S.E. , Saman D.M. , Dehmer S.P. , Ekstrom H.L. , Allen C.I. , Bianco J.A. , Chrenka E.A. , Freitag L.A. , et al. .
Source: Contemporary clinical trials, 2021 Mar; 102, p. 106271.
EPub date: 2021-01-24.
PMID: 33503497
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Pre-implementation adaptation of primary care cancer prevention clinical decision support in a predominantly rural healthcare system.
Authors: Harry M.L. , Saman D.M. , Truitt A.R. , Allen C.I. , Walton K.M. , O'Connor P.J. , Ekstrom H.L. , Sperl-Hillen J.M. , Bianco J.A. , Elliott T.E. .
Source: BMC medical informatics and decision making, 2020-06-23; 20(1), p. 117.
EPub date: 2020-06-23.
PMID: 32576202
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Understanding primary care providers' perceptions of cancer prevention and screening in a predominantly rural healthcare system in the upper Midwest.
Authors: Saman D.M. , Walton K.M. , Harry M.L. , Asche S.E. , Truitt A.R. , Henzler-Buckingham H.A. , Allen C.I. , Ekstrom H.L. , O'Connor P.J. , Sperl-Hillen J.M. , et al. .
Source: BMC health services research, 2019-12-30; 19(1), p. 1019.
EPub date: 2019-12-30.
PMID: 31888630
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Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study.
Authors: Harry M.L. , Truitt A.R. , Saman D.M. , Henzler-Buckingham H.A. , Allen C.I. , Walton K.M. , Ekstrom H.L. , O'Connor P.J. , Sperl-Hillen J.M. , Bianco J.A. , et al. .
Source: BMC health services research, 2019-07-31; 19(1), p. 534.
EPub date: 2019-07-31.
PMID: 31366355
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Priorities Wizard: Multisite Web-Based Primary Care Clinical Decision Support Improved Chronic Care Outcomes with High Use Rates and High Clinician Satisfaction Rates.
Authors: Sperl-Hillen J.M. , Rossom R.C. , Kharbanda E.O. , Gold R. , Geissal E.D. , Elliott T.E. , Desai J.R. , Rindal D.B. , Saman D.M. , Waring S.C. , et al. .
Source: EGEMS (Washington, DC), 2019-04-03; 7(1), p. 9.
EPub date: 2019-04-03.
PMID: 30972358
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