Few previous studies have applied the hybrid effectiveness-implementation design framework to illustrate the way in which an intervention was progressively implemented and evaluated across multiple studies in diverse settings. We describe the design components and methodologies of three studies that sought to improve rates of colorectal cancer (CRC) screening using mailed outreach, and apply domains put forth by Curran et al.: research aims, research questions, comparison conditions, sample, evaluation methods, measures, and potential challenges. The Hybrid 1 study (emphasis on effectiveness) was a patient-level randomized trial of a mailed fecal test and stepped phone-outreach intervention program delivered in an integrated healthcare system (21 clinics, 4673 patients). The primary outcome was effectiveness (CRC screening uptake). Implementation outcomes included cost-effectiveness and acceptability. The Hybrid 2 study (shared emphasis on effectiveness and implementation) was a pragmatic cluster-randomized trial of mailed fecal immunochemical test (FIT) outreach implemented at safety net clinics (26 clinics, 41,000 patients). The intervention used electronic health record tools (adapted from Hybrid 1) and clinic personnel to deliver the intervention. Outcomes included effectiveness (FIT completion) and implementation (FIT kits delivered, clinic barriers and facilitators, cost-effectiveness). Hybrid 3 study (emphasis on implementation) is a demonstration project being conducted by two Medicaid/Medicare insurance plans (2 states, 12,000 patients) comparing two strategies for implementing mailed FIT programs that addressed Hybrid 2 implementation barriers. Outcomes include implementation (activities delivered, barriers) and effectiveness (FIT completion). The effectiveness-implementation typology successfully identified a number of distinguishing features between the three studies. Two additional features, program design and program delivery, varied across our studies, and we propose adding them to the current typology. Program design and program delivery reflect the process by which and by whom a program is designed and delivered (e.g., research staff vs. clinic/health plan staff). We describe three studies that demonstrate the hybrid effectiveness to implementation continuum and make recommendations for expanding the hybrid typology to include new descriptive features. Additional comparisons of Hybrid 1, 2, and 3 studies may help confirm whether our hybrid typology refinements are generalizable markers of the pipeline from research to practice.

中文翻译：

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使用连续的混合有效性实施研究，将经过研究测试的结肠直肠筛查干预措施付诸实践

很少有先前的研究使用混合有效性实施设计框架来说明在多种情况下跨多个研究逐步实施和评估干预措施的方式。我们描述了三项旨在通过邮寄外展来提高结直肠癌（CRC）筛查率的研究的设计成分和方法，并应用了Curran等人提出的领域：研究目的，研究问题，比较条件，样品，评估方法，措施和潜在挑战。混合1研究（强调有效性）是在综合医疗保健系统（21个诊所，4673位患者）中进行的邮寄粪便测试和电话扩展干预计划的患者水平随机试验。主要结果是有效性（CRC筛查摄取）。实施成果包括成本效益和可接受性。混合2研究（共同强调有效性和实施）是在安全网诊所（26个诊所，41,000例患者）实施的邮寄粪便免疫化学测试（FIT）外展的实用集群随机试验。干预措施使用了电子健康记录工具（从Hybrid 1改编而成）和诊所人员来进行干预。结果包括有效性（FIT完成）和实施（交付的FIT套件，临床障碍和促进者，成本效益）。混合3研究（强调实施）是一个由两个Medicaid / Medicare保险计划（两个州，12,000名患者）进行的示范项目，比较了实施邮寄FIT计划的两种策略，这些策略解决了混合2实施的障碍。结果包括实施（交付的活动，障碍）和有效性（完成信托投资）。有效性-实施类型学成功地确定了这三项研究之间的许多区别特征。程序设计和程序交付这两个附加功能因我们的研究而异，我们建议将其添加到当前的类型学中。计划设计和计划交付反映了计划和由谁设计和交付计划的过程（例如，研究人员vs.诊所/健康计划人员）。我们描述了三项研究，这些研究证明了混合对实施连续性的有效性，并为扩展混合类型以包括新的描述性功能提出了建议。混合动力1、2的其他比较