Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
BMJ Open. 2019 Jan 7;9(1):e023986. doi: 10.1136/bmjopen-2018-023986.
How to provide practice-integrated decision support to patients remains a challenge. We are testing the effectiveness of a practice-integrated programme targeting patients with a physician recommendation for colorectal cancer (CRC) screening.
In partnership with healthcare teams, we developed 'e-assist: Colon Health', a patient-targeted, postvisit CRC screening decision support programme. The programme is housed within an electronic health record (EHR)-embedded patient portal. It leverages a physician screening recommendation as the cue to action and uses the portal to enrol and intervene with patients. Programme content complements patient-physician discussions by encouraging screening, addressing common questions and assisting with barrier removal. For evaluation, we are using a randomised trial in which patients are randomised to receive e-assist: Colon Health or one of two controls (usual care plus or usual care). Trial participants are average-risk, aged 50-75 years, due for CRC screening and received a physician order for stool testing or colonoscopy. Effectiveness will be evaluated by comparing screening use, as documented in the EHR, between trial enrollees in the e-assist: Colon Health and usual care plus (CRC screening information receipt) groups. Secondary outcomes include patient-perceived benefits of, barriers to and support for CRC screening and patient-reported CRC screening intent. The usual care group will be used to estimate screening use without intervention and programme impact at the population level. Differences in outcomes by study arm will be estimated with hierarchical logit models where patients are nested within physicians.
All trial aspects have been approved by the Institutional Review Board of the health system in which the trial is being conducted. We will disseminate findings in diverse scientific venues and will target clinical and quality improvement audiences via other venues. The intervention could serve as a model for filling the gap between physician recommendations and patient action.
NCT02798224; Pre-results.
如何为患者提供整合实践的决策支持仍然是一个挑战。我们正在测试针对接受医生推荐进行结直肠癌（CRC）筛查的患者的整合实践计划的有效性。
我们与医疗保健团队合作，开发了“e 辅助：结肠健康”，这是一个针对患者的、就诊后 CRC 筛查决策支持计划。该计划位于电子健康记录（EHR）嵌入式患者门户中。它利用医生的筛查推荐作为行动提示，并利用门户招募和干预患者。计划内容通过鼓励筛查、解决常见问题和协助消除障碍，补充医患讨论。为了评估，我们正在使用一项随机试验，其中患者被随机分配接受 e 辅助：结肠健康或两种对照（常规护理加或常规护理）之一。试验参与者是平均风险、年龄在 50-75 岁之间、需要进行 CRC 筛查并收到医生开具粪便检测或结肠镜检查医嘱的患者。将通过比较电子病历中记录的筛查使用情况来评估有效性，该记录包括 e 辅助：结肠健康和常规护理加（CRC 筛查信息接收）组的试验参与者。次要结果包括患者对 CRC 筛查的感知益处、障碍和支持以及患者报告的 CRC 筛查意向。将使用常规护理组估计没有干预和计划对人群层面的筛查影响。将使用分层逻辑模型估计研究臂之间的结果差异，其中患者嵌套在医生中。
所有试验方面均已获得正在进行试验的卫生系统机构审查委员会的批准。我们将在各种科学场所传播研究结果，并通过其他场所针对临床和质量改进受众。该干预措施可以作为填补医生建议和患者行动之间差距的模型。
NCT02798224；预结果。
