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Evaluation - experience in internet and primary care settings

Evaluation - experience in internet and primary care settings . Graham A. Colditz. What I do. Research on dissemination of office systems in primary care to promote colorectal screening (ACS- TIOG)

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Evaluation - experience in internet and primary care settings

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  1. Evaluation - experience in internet and primary care settings Graham A. Colditz

  2. What I do • Research on dissemination of office systems in primary care to promote colorectal screening (ACS- TIOG) • Web site development with evidence based recommendations for lifestyle changes to reduce cancer risk: (yourcancerrisk.harvard.edu), and deal with challenge of evaluation

  3. RCTs of Office Systems • Dietrich et al (1992) • Tailored materials • Facilitator model • Provide support toward implementing new routines • Showed maintenance of increased FOBT

  4. ACS innovation grant Objective To evaluate the feasibility of implementing low-cost office-systems towards improving CRC behaviors in real-world primary care practices in 3 states in New England Wei EK, et. al. Arch Internal Med 2005:165:661-6

  5. Targeted Areas for Improvement • To educate patients • To identify patients overdue for screening • To enable adherence to FOBT recommendations • To monitor adherence to FOBT recommendations • To notify patients of normal and abnormal test results

  6. Recruitment • Identified 5594 primary care clinicians in MA, NH, and CT through a retail database • Mailed invitation letters and response postcards to 1,972 clinicians • 14% responded with interest (n=276) • 11% responded as not interested • 72% did not respond • 3% were unreachable • Enrolled 185 primary care clinicians (67%)

  7. Study Population Provider Type • Physician (MD or DO) State • New Hampshire • Massachusetts • Connecticut Practice model • Private practice Type of practice • Group n (%) 147 (79%) 79 (43%) 69 (37%) 37 (20%) 99 (54%) 164 (89%)

  8. Office Environment • 43% reported being short-staffed • 32% had significant turnover in past six months • 21% reported changes in practice leadership in past six months • 2% had relocated in past six months

  9. Evaluation: Data Collection • Questionnaires completed by providers at baseline and follow-up • Based on questionnaire used by the MA CRC Working Group • Questioned providers about CRC screening process • Independent medical record review company extracted data from participating providers’ patient charts

  10. Limitations • Screening recommendations proxy for colorectal cancer mortality Polyp removal data is not widely available • Providers who participated were motivated • Chart audit data may not have been representative • Sample size

  11. Challenges • Several screening modalities and varying intervals • Confusing to patients • Providers must spend time discussing options with patients • Providers need to be well-educated on various tests and appropriate follow-up for each • Up-to-date status not straightforward to calculate or analyze • Flexibility versus rigorous methods • Changes in mortality require prohibitively long follow-up

  12. Opportunities • Methods to evaluate the impact of dissemination projects are not well developed • Disseminate to a wider population • American Cancer Society, • Centers for Disease Control

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