A Multi-modal, Physician-centered Intervention to Improve Guideline-concordant Prostate Cancer Imaging
概览
- 阶段
- 不适用
- 干预措施
- Clinical Order Check
- 疾病 / 适应症
- Prostate Cancer
- 发起方
- VA Office of Research and Development
- 入组人数
- 58
- 试验地点
- 11
- 主要终点
- Facility-level Inappropriate Prostate Cancer Bone Scan Imaging Rates
- 状态
- 进行中（未招募）
- 最后更新
- 上个月
概览
简要总结
The primary aim of this study is to determine whether a multi-modal, physician-focused behavioral intervention can improve facility-level guideline-concordant utilization of prostate cancer staging imaging. Other aims of this study include to use mixed methods to explore physician influence on guideline-concordant imaging and to determine the cost and cost impact of a physician-focused behavioral intervention to improve guideline-concordant prostate cancer imaging.
详细描述
Almost half of Veterans with localized prostate cancer (the most common non-cutaneous malignancy among US men) receive inappropriate, wasteful imaging. The VHA Blueprint for Excellence prioritizes increasing operational effectiveness. Prior studies seeking to limit inappropriate imaging did not assess barriers and achieved mixed results. The investigators' team has explored the causes of guideline-discordant prostate cancer imaging and found that 1) patients with newly diagnosed prostate cancer have little concern for radiographic staging but rather focus on treatment, 2) physician trust imaging guidelines but are apt to follow their own intuition, fear medico-legal consequences, and succumb to influence from colleagues who image frequently. In spite of such discrepant views, most VHA physicians suggested or supported a large-scale effort to improve imaging use across VHA. The investigators propose a multi-site, stepped wedge, cluster-randomized trial to determine the effect of a physician-focused behavioral intervention on VHA prostate cancer imaging use. The multi-level intervention, developed according to the Theoretical Determinants Framework, combines traditional physician behavior change methods with novel methods of communication and data collection. The intervention consists of three components: 1) a system of audit and feedback to clinicians informing individual clinicians and their sites about how their behavior compares to their peers' and to published guidelines 2) a program of academic detailing with the goal to educate providers about prostate cancer imaging, and 3) a CPRS Clinical Order Check for potentially inappropriate imaging. The intervention will be introduced to 10 participating geographically-distributed study sites. The investigators will assess imaging rates 6 months prior to the intervention and 3 months following the intervention. The study's specific aims seek to understand the effects of the intervention on 1) facility-level prostate cancer imaging rates, 2) physician experience with and perceptions of the intervention and its implementation, and 3) the costs of both implementing the intervention and affecting change in imaging use. These aims will support a subsequent intervention to improve guideline-concordant imaging across VHA. Experience gained through this project will be leveraged to improve guideline-concordant care and increase operational effectiveness in other domains.
研究者
入排标准
入选标准
- •Provider Criteria:
- •Urology Chiefs and attending urologists employed through the VA (full time, part time) at one of the 10 participating sites
- •Physician Assistants and Nurse Practitioners employed through the VA at one of the 10 participating sites that work in the respective urology clinics
- •Providers may be any gender or race/ethnicity
- •Qualitative portion only:
- •Urology Chiefs and/or frontline staff physicians
- •participating PAs \& NPs having cared for at least 5 men with incident prostate cancer within the previous 6 months
- •Patients will not be directly recruited into the study.
- •The investigators have obtained a waiver of HIPAA authorization and informed consent to analyze electronic health records of patients that are diagnosed with ICD-9 code 185 or ICD-10 code C61 during the study period at the 10 participating sites.
排除标准
- •Provider Criteria:
- •Urology Residents will be excluded.
- •Patients will be excluded if they have a history of prior malignancy
- •Are over the age of 85
- •Diagnosed at autopsy or by death certificate
- •Died within 3 months of diagnosis
- •Not having data on at least one of the following:
- •clinical stage
- •Gleason score
研究组 & 干预措施
Intervention
The intervention is comprised of three components: 1) Clinical Order Check, 2) Academic Detailing, and 3) Audit and Feedback.
干预措施: Clinical Order Check
Control
No intervention
Intervention
The intervention is comprised of three components: 1) Clinical Order Check, 2) Academic Detailing, and 3) Audit and Feedback.
干预措施: Academic Detailing
Intervention
The intervention is comprised of three components: 1) Clinical Order Check, 2) Academic Detailing, and 3) Audit and Feedback.
干预措施: Audit and Feedback
结局指标
主要结局
Facility-level Inappropriate Prostate Cancer Bone Scan Imaging Rates
时间窗: Through study completion, an average of 4 years
Facility-level utilization of bone scan imaging among men with newly diagnosed, low-risk prostate cancer. (Inappropriate Imaging according to NCCN guidelines)
Facility-level Appropriate Prostate Cancer Bone Scan Imaging Rates
时间窗: Through study completion, an average of 4 years
Facility-level utilization of bone scan imaging among men with newly diagnosed, high-risk prostate cancer. (Appropriate Imaging according to NCCN guidelines)
次要结局
- Individual-level Inappropriate Prostate Cancer Imaging Rates(Through study completion, an average of 4 years)
- Provider Attitudes Regarding Prostate Cancer Imaging Guidelines and the Behavioral Intervention(Through study completion, an average of 4 years)
- Individual-level Appropriate Prostate Cancer Imaging Rates(Through study completion, an average of 4 years)