Comparing Strategies for Implementing Primary HPV Screening
Comparing Strategies for Implementing Primary HPV Testing for Routine Cervical Cancer Screening
調査の概要
詳細な説明
Definition: Extended description of the protocol, including more technical information (as compared to the Brief Summary), if desired. Do not include the entire protocol; do not duplicate information recorded in other data elements, such as Eligibility Criteria or outcome measures.
Limit: 32,000 characters.
Background and Significance: Strong evidence supports testing for the high risk human papillomavirus (HPV) infection, the etiology agent of cervical cancer, in routine cervical cancer screening. In 2014, the FDA approved the first test for primary HPV screening. Between 2015 and 2017, professional societies and national guideline bodies released practice recommendation for primary HPV screening. However, none of the large health care systems in the U.S. have systematically adopted this new screening strategy. Kaiser Permanente Southern California (KPSC) is preparing to transition to primary HPV screening in 2019, with considerable expected impact and barriers at multiple levels. There is a critical gap of knowledge on effective strategies to guide implementation of uptake of new evidence-based practice, especially around cancer screening where changes to clinical practice guidelines often created confusion among clinicians and patients. The overarching goals of this application is to generate insights and evidence regarding barriers and facilitators and effective strategies to achieve clinical practice substitution. Study Aims: SA1) Compare a local-tailored vs. a centralized approach for facilitating adoption of primary HPV testing for cervical cancer screening on (a) implementation outcomes including uptake of primary HPV screening, acceptability, appropriateness and feasibility; and (b) stakeholder-centered outcomes including knowledge, experience, behavior and satisfaction; SA2) Explain variations in implementation strategy effectiveness on study outcomes by multi-level factors; and SA3) Develop guidance for use of the effective implementation strategies in additional settings and for additional implementation problems. Study Descriptions: We will conduct a prospective, cluster randomized programmatic trial to compare and evaluate a local-tailored versus a centralized implementation approach. The local tailoring strategy will be guided by a structured process, using a menu of core functions and forms with evidence-based barrier assessment and intervention options. The centralized implementation will be based on the prevalent KPSC regional approach to new practice implementation, involving the design of a multi-component approach that is delivered in a relatively consistent manner. Twelve of the 14 KPSC medical centers will be randomized to receive one of the two implementation approaches, with two medical centers serving as pilot sites. The study subject will include screening age women, primary care and obstetrics & gynecology physicians, as well as clinic staff, administrators and operational leaders. The primary outcome of interest is uptake of primary HPV screening at the provider level. The secondary outcomes include stakeholder-centered outcomes such as knowledge and satisfaction, and additional implementation and system outcomes as well as implementation process evaluation. Data collection will be via electronic medical record extraction, patient and provider surveys, and semi-structured key-informant interviews. Multi-level models and generalized estimating equations will be used to evaluate the effect of the local-tailored approach on each outcomes of interest. Effect heterogeneity by multi-level factors will be examined by interaction terms. Content analysis will be used to evaluate qualitative data collected for Aims 1 and 3. We will use the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) to inform our overall study approach and provide rigor and structure to our analyses.
研究の種類
入学 (予想される)
段階
- 適用できない
連絡先と場所
研究連絡先
- 名前:Chunyi Hsu, MPH
- 電話番号:626-564-3508
- メール:chunyi.hsu@kp.org
研究連絡先のバックアップ
- 名前:Nancy Cannizzaro, PhD
- 電話番号:626-564-7663
- メール:nancy.takahashi@kp.org
研究場所
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California
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Pasadena、California、アメリカ、91101
- 募集
- Kaiser Permanente Southern California
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コンタクト:
- Chunyi Hsu, MPH
- 電話番号:626-564-3508
- メール:chunyi.hsu@kp.org
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コンタクト:
- Nancy Cannizzaro, PhD
- 電話番号:626-564-7663
- メール:nancy.takahashi@kp.org
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
This is a cluster randomized trial. All KPSC's 12 service areas except Orange Country will be randomized and included in this study. All providers (physicians, nurses and medical assistants) and department administrator from the primary care departments (family medicine and internal medicine) and the department of obstetrics and gynecology at these 12 service areas randomized to this arm will be included in the study, as well as female patients at these service areas between age 30-65 who received cervical cancer screening during the data collection period.
Exclusion Criteria:
- Patients who are younger than 30 years old
- Providers working for departments other than Ob/Gyn, family or internal medicine
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:他の
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:Local Tailoring
The intervention arm will consist of six KPSC service areas randomly assigned to the intervention arm.
Immediately after primary HPV screening opens at KPSC, the intervention arm will receive the local tailoring interventions.
All providers (physicians, nurses and medical assistants) and department administrator from the primary care departments (family medicine and internal medicine) and the department of obstetrics and gynecology at these six service areas randomized to this arm will be included in the study, as well as female patients at these service areas between age 30-65 who received cervical cancer screening during the data collection period.
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The "guided local tailoring" approach will employ a standard structured process, including (1) convening a project team, (2) conducting a local diagnostic process to identify likely barriers using provider/patient survey and interviews with providers/administrators, (3) selecting from a pre-developed menu of implementation strategies categorized by core function (form and function menu), and (4) deploying the selected strategies in collaboration with local implementation and improvement consultants.
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介入なし:Hybrid Usual Care
The hybrid-usual care arm will consist of six KPSC service areas randomly assigned to this arm.
The hybrid usual care arm will receive regional educational activities for the transition (as will the intervention arm) before the roll out of primary HPV testing.
However, they will not receive any research-led intervention or adaptation guidance after primary HPV screening opens at KPSC.
All providers (physicians, nurses and medical assistants) and department administrator from the primary care departments (family medicine and internal medicine) and the department of obstetrics and gynecology at these six service areas randomized to this arm will be included in the study, as well as female patients at these service areas between age 30-65 who received cervical cancer screening during the data collection period.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Uptake of primary HPV testing
時間枠:Within the 3 months after the end of the 2 months intervention window
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Proportion of primary HPV testing of all cervical cancer screening performed for women age 30-65 at the provider level.
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Within the 3 months after the end of the 2 months intervention window
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Provider-centered outcomes
時間枠:Within the 3 months after the end of the 2 months intervention window
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Knowledge about the efficacy of the new test.
We will assess provider knowledge via provider surveys which elicits information on provider knowledge and practice on cervical cancer screening.
Provider delivery of education during patient screening visit will be measured in provider survey, including whether education is delivered and average time spent on patient education/counseling. Provider/staff satisfaction of the transition process and provider resistance to the new screening modality will be ascertained via survey questions.
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Within the 3 months after the end of the 2 months intervention window
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Patient-centered outcomes
時間枠:Within the 3 months after the end of the 2 months intervention window
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Knowledge about the new test and why the change is made.
To measure this outcome, we will use and modify validated survey questions on HPV test knowledge.
Emotional reactions (stigma and shame) of a positive HPV test result will be measured using survey questions developed by Waller et al.
Patient satisfaction during the transition may be measured with survey questions such as "Were you able to discuss all your concerns/questions about the new screening approach with your provider?"
"Where these concerns/questions adequately addressed?"
"Did you get your test result back in a timely manner?"
"Did someone explain to you what the test result mean?" and "How satisfy are you with the screening experience?"
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Within the 3 months after the end of the 2 months intervention window
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Time to colposcopy after a positive test result
時間枠:Within the 6 months after the end of the 2 months intervention window
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Time to colposcopy after a positive test result represents the combination of correct and timely referral, patient compliance, and availability of colposcopy appointments and will be measured using laboratory and utilization data collected in KPSC's electronic medical records.
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Within the 6 months after the end of the 2 months intervention window
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協力者と研究者
スポンサー
捜査官
- 主任研究者:Chun R Chao, PhD、KPSC Department of Research and Evaluation
- 主任研究者:Devansu Tewari, MD、KPSC Orange County Medical Center Department of Obstetrics and Gynecology
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (予想される)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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