Population Management for Hereditary Cancer Prevention: Implementation, Effectiveness, and Acceptability within a Learning Health System.

项目总结/摘要 这个指导临床科学家研究职业发展奖（K 08）的目的是提供博士。 Sarah Knerr拥有培训，指导，研究经验和受保护的时间，将她的职业生涯过渡到 基因组医学和发展成为一个独立的学术研究者。Knerr博士在公共场合有MPH 健康遗传学和健康服务研究博士学位。她目前是大学的代理助理教授 来自华盛顿卫生服务部。她的职业目标包括：（1）开展卫生服务 增加基因组医学文献的普遍性和相关性的研究，（2）成为一个 评估基因组医疗保健提供干预措施的专家，（3）使用实施科学工具， 加速基因组翻译，以及（4）获得资助，以支持跨学科的研究事业。的 在这个为期三年的K 08奖项中概述的教学和体验培训活动将为她提供 在学习卫生保健系统中领导务实研究的基本技能，评估卫生保健 程序使用准实验设计，应用实施科学的理论和方法， 基因组医疗保健服务，并开发有竞争力的赠款申请。补充研究 项目利用遗传性乳腺癌和卵巢癌（HBOC）人群管理的启动 凯萨永久华盛顿（KPWA）卫生系统内的计划。基于Knerr博士之前的研究 研究KPWA内BRCA测试的使用趋势，并通过以下具体目标，拟议的研究 将产生关于以人群为中心的实施，有效性和可接受性的新数据 遗传性癌症基因组学的医疗保健提供计划。目标1将确定方案实施情况 利用人种学观察、文件审查和关键知情人访谈的障碍和促进因素。目的2 将使用访谈来调查病人的经验，满意度，和信息需求的背景下， 临床HBOC人口管理计划。目标3将确定遗传咨询的项目效果 KPWA人群中的转诊和遗传服务利用情况， 数据和中断的时间序列研究设计。这项工作支持了目前在基因组方面的国家优先事项， 医学和遗传性癌症的预防和控制。研究结果可以为实施 跨疾病领域的基因组筛查计划，开发翻译所需的临床基础设施， 基因组的进步转化为人口水平的健康改善。优秀的导师和顾问团队 在基因组医学、癌症预防和控制、实施科学、健康计划方面具有专长 评估和中断的时间序列分析将支持Knerr博士的培训和研究目标。的 K 08活动为未来专注于改进和测试实现的R级应用程序奠定了基础 战略和支持HBOC人口管理计划以及长期的后续研究 计划结果（例如，KPWA系统内的风险管理吸收、生活质量、成本）。

PROJECT SUMMARY/ABSTRACT The objective of this Mentored Clinical Scientist Research Career Development Award (K08) is to provide Dr. Sarah Knerr with training, mentoring, research experience, and protected time to transition her career into genomic medicine and develop into an independent academic researcher. Dr. Knerr has an MPH in public health genetics and a PhD in health services research. She is currently Acting Assistant Professor, University of Washington Department of Health Services. Her career goals include: (1) conducting health services research that increases the generalizability and relevance of the genomic medicine literature, (2) becoming an expert in evaluating genomic health care delivery interventions, (3) using implementation science tools to accelerate genomic translation, and (4) obtaining funding to support an interdisciplinary research career. The didactic and experiential training activities outlined in this three-year K08 award will thus provide her with essential skills in leading pragmatic research within learning health care systems, evaluating health care programs using quasi-experimental designs, applying implementation science theories and methods to genomic health care delivery, and developing competitive grant applications. The complementary research project leverages the launch of a hereditary breast and ovarian cancer (HBOC) population management program within the Kaiser Permanente Washington (KPWA) health system. Building on Dr. Knerr’s prior work studying BRCA test utilization trends within KPWA, and through the following specific aims, the proposed study will generate novel data about the implementation, effectiveness, and acceptability of population-focused health care delivery programs in hereditary cancer genomics. Aim 1 will identify program implementation barriers and facilitators using ethnographic observation, document review, and key informant interviews. Aim 2 will use interviews to investigate patient experiences, satisfaction, and informational needs in the context of a clinical HBOC population management program. Aim 3 will determine program effects on genetic counseling referral and genetic services utilization within the KPWA population using routinely collected administrative data and an interrupted time series study design. This work supports current national priorities in genomic medicine and hereditary cancer prevention and control. Study findings can inform the implementation of genomic screening programs across disease areas, developing the clinical infrastructure needed to translate genomic advances into population-level health improvements. An outstanding team of mentors and advisors with expertise in genomic medicine, cancer prevention and control, implementation science, health program evaluation, and interrupted time series analysis will support Dr. Knerr in her training and research goals. The K08 activities lay the foundation for future R-level applications focused on refining and testing implementation strategies and supports for HBOC population management programs as well as follow-up studies of long-term program outcomes (e.g., risk-management uptake, quality of life, costs) within the KPWA system.