Creating a "culture of research'' in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program
Creating a "culture of research'' in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program
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DOI：
10.1177/1740774515571141
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发表时间：
2015-06-01
期刊：
影响因子：
2.7
通讯作者：
McCaskill-Stevens, Worta
中科院分区：
文献类型：
--
作者：
Dimond, Eileen P.;St Germain, Diane;McCaskill-Stevens, Worta
背景 以社区为基础的癌症研究的价值早已得到认可。除了分别于 1983 年和 1991 年建立的国家癌症研究所社区临床和少数族裔肿瘤学计划外，国家癌症研究所还于 2007 年建立了国家癌症研究所社区癌症中心计划，旨在提高大多数癌症患者接受治疗的社区环境中获得高质量癌症护理和临床研究的机会。本文讨论了美国国家癌症研究所社区癌症中心计划在 7 年期间为参与该计划的社区医院建设研究能力和创建更根深蒂固的研究文化所采用的策略。方法为了促进社区医院研究文化的发展，国家癌症研究所社区癌症中心计划需要领导或首席执行官的参与；利用协作学习结构，可以分享最佳实践、成功和挑战；促进站点到站点的指导，以促进站点内部和站点之间更快的学习；所需的研究项目评估涵盖临床试验组合、应计障碍和外展；增加指标的识别和使用；最后，鼓励跨医院部门（导航、多学科护理、病理学和差异）的研究团队参与，以取代传统的孤立的临床试验方法。 局限性随着研究复杂性的增加，医疗保健环境正在迅速变化。成功的研究工作受到许多因素的影响（例如机构审查委员会的审查、医生的兴趣和试验的可用性）。国家癌症研究所社区癌症中心项目站点作为项目参与者，可以获得制定和实施所述策略所需的资源和支持。指标是一个重要组成部分，但识别和收集往往具有挑战性。该模式要求高度重视外展活动，这要求医院改善和扩大其覆盖范围，特别是在代表性不足的人群和服务区域。这些努力建立在社区内的信任和转诊渠道的基础上，而这需要时间和重大承诺来建立。结论国家癌症研究所社区癌症中心计划的经验提供了一个相关模型，可以广泛地解决在通过系统和联盟日益联网的社区医院中创建研究文化的问题。所使用的策略与美国国家癌症研究所美国临床肿瘤学会应计研讨会对患者/社区、医生/提供者和场所/组织层面的临床试验方法的建议非常一致；他们帮助研究中心实现了组织文化转变，从而增强了其癌症研究项目。美国国家癌症研究所社区癌症中心计划医院报告称，这些策略实施起来具有挑战性，但事实证明很有价值，因为它们为计划评估、规划、报告和发展提供了有用的指标。虽然重点关注肿瘤学试验，但这些概念在其他以疾病为重点的研究中也可能有用。
Background The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute's Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period.Methods To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials.Limitations The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important component yet often challenging to identify and collect. The model requires a strong emphasis on outreach that challenges hospitals to improve and expand their reach, particularly into underrepresented populations and catchment areas. These efforts build on trust and a referral pipeline within the community which take time and significant commitment to establish.Conclusion The National Cancer Institute Community Cancer Centers Program experience provides a relevant model to broadly address creating a culture of research in community hospitals that are increasingly networked via systems and consortiums. The strategies used align well with the National Cancer InstituteAmerican Society of Clinical Oncology Accrual Symposium recommendations for patient-/community-, physician-/provider-, and site-/organizational-level approaches to clinical trials; they helped sites achieve organizational culture shifts that enhanced their cancer research programs. The National Cancer Institute Community Cancer Centers Program hospitals reported that the strategies were challenging to implement yet proved valuable as they provided useful metrics for programmatic assessment, planning, reporting, and growth. While focused on oncology trials, these concepts may be useful within other disease-focused research as well.