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.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA060862-05
Application #
2748748
Study Section
Special Emphasis Panel (HSDG)
Program Officer
Meissner, Helen I
Project Start
1994-05-01
Project End
2000-07-31
Budget Start
1998-08-01
Budget End
1999-07-31
Support Year
5
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Case Western Reserve University
Department
Family Medicine
Type
Schools of Medicine
DUNS #
077758407
City
Cleveland
State
OH
Country
United States
Zip Code
44106
Goodwin, Meredith A; Stange, Kurt C; Zyzanski, Stephen J et al. (2017) The Hawthorne effect in direct observation research with physicians and patients. J Eval Clin Pract 23:1322-1328
Crabtree, Benjamin F; Nutting, Paul A; Miller, William L et al. (2011) Primary care practice transformation is hard work: insights from a 15-year developmental program of research. Med Care 49 Suppl:S28-35
Ruhe, Mary C; Bobiak, Sarah N; Litaker, David et al. (2011) Appreciative Inquiry for quality improvement in primary care practices. Qual Manag Health Care 20:37-48
Ruhe, Mary C; Carter, Caroline; Litaker, David et al. (2009) A systematic approach to practice assessment and quality improvement intervention tailoring. Qual Manag Health Care 18:268-77
Bobiak, Sarah N; Zyzanski, Stephen J; Ruhe, Mary C et al. (2009) Measuring practice capacity for change: a tool for guiding quality improvement in primary care settings. Qual Manag Health Care 18:278-84
Lanham, Holly J; McDaniel Jr, Reuben R; Crabtree, Benjamin F et al. (2009) How improving practice relationships among clinicians and nonclinicians can improve quality in primary care. Jt Comm J Qual Patient Saf 35:457-66
Weyer, Sharon M; Bobiak, Sarah; Stange, Kurt C (2008) Possible unintended consequences of a focus on performance: insights over time from the research association of practices network. Qual Manag Health Care 17:47-52
Flocke, Susan A; Litaker, David (2007) Physician practice patterns and variation in the delivery of preventive services. J Gen Intern Med 22:191-6
Carter, Caroline A; Ruhe, Mary C; Weyer, Sharon et al. (2007) An appreciative inquiry approach to practice improvement and transformative change in health care settings. Qual Manag Health Care 16:194-204
Litaker, David; Flocke, Susan A; Frolkis, Joseph P et al. (2005) Physicians' attitudes and preventive care delivery: insights from the DOPC study. Prev Med 40:556-63

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