Tate Channing E, Matlock Daniel D, Dalton Alexandra F, Schilling Lisa M, Marcus Alexandra, Schommer Tiffany, Lyon Corey, Lewis Carmen L
Jt Comm J Qual Patient Saf. 2018 Jun;44(6):353-360. doi: 10.1016/j.jcjq.2017.11.009. Epub 2018 Apr 25.
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States; however, CRC screening reduces both incidence and mortality rates. Patient decision aids (DAs) are an evidence-based strategy to support patients making health-related decisions. CRC screening DAs can be unsuccessful due to provider preferences for colonoscopy and lack of effective DA implementation strategies within clinical settings.
A hybrid implementation-effectiveness study was conducted testing the feasibility of using an existing centralized preventive health screening outreach infrastructure to implement a novel CRC DA across a health care system. Participants included primary care patients at one of three study clinics. Implementation was assessed by determining whether patients remembered receiving the DA and were aware of CRC screening options. Effectiveness was measured by comparing overall screening rates between the control and intervention groups.
Using a centralized delivery system was a feasible and efficient method for implementing DAs to a large academic health system. More than 90% of the intervention group remembered receiving the DA, and 80% found it helpful in their decision-making process. The DA was successful in improving CRC screening knowledge; however, overall CRC screening rates significantly decreased between the control and intervention periods (50.8% vs. 39.2%, respectively; p = 0.03).
Centralized delivery is a feasible method for DA implementation. Although DAs increase knowledge, the true effectiveness of CRC DAs in clinical settings is unknown, as a result of the number in screening tests, diversity in DA format, and the variability in dissemination and implementation practices.
在美国，结直肠癌（CRC）是癌症相关死亡的第二大主要原因；然而，CRC筛查可降低发病率和死亡率。患者决策辅助工具（DAs）是一种基于证据的策略，用于支持患者做出与健康相关的决策。由于临床医生对结肠镜检查的偏好以及临床环境中缺乏有效的DA实施策略，CRC筛查DAs可能并不成功。
开展了一项混合实施-效果研究，测试利用现有的集中式预防性健康筛查推广基础设施在整个医疗系统中实施一种新型CRC DA的可行性。参与者包括三个研究诊所之一的初级保健患者。通过确定患者是否记得收到DA并了解CRC筛查选项来评估实施情况。通过比较对照组和干预组的总体筛查率来衡量效果。
使用集中式交付系统是向大型学术医疗系统实施DAs的一种可行且有效的方法。超过90%的干预组患者记得收到了DA，80%的患者认为它对其决策过程有帮助。该DA成功提高了CRC筛查知识；然而，对照组和干预期之间的总体CRC筛查率显著下降（分别为50.8%和39.2%；p = 0.03）。
集中式交付是实施DA的一种可行方法。尽管DAs增加了知识，但由于筛查测试的数量、DA格式的多样性以及传播和实施实践的变异性，CRC DAs在临床环境中的真正效果尚不清楚。
