Research Project 2

研究项目2

• 批准号: 10207430
• 负责人: Simona Kwon
• 金额: $ 8.48万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10207430
• 关键词: Abdomen; Accounting; Address; Adherence; Adoption; Antibiotic Therapy; Asian Americans; Asians; Bacteria; Cancer Burden; Cancer Etiology; Cancer Intervention; Carcinogens; Cardiovascular Diseases; Caring; Cause of Death; China; Chinese American; Clinic; Clinical Decision Support Systems; Communities; Community Health Aides; Data; Disease; Dyspepsia; Early Diagnosis; Effectiveness; Electronic Health Record; Endoscopy; Enrollment; Ethnic group; Evaluation; Funding; Goals; Health; Health system; Healthcare Systems; Helicobacter Infections; Helicobacter pylori; Hospitals; Human; Immigrant; Incidence; Infection; Intervention; Lead; Limited English Proficiency; Linguistics; Link; Low income; Malignant Neoplasms; Methods; Modeling; New York City; Not Hispanic or Latino; Observational Study; Patient Education; Patients; Population; Prevention; Prevention Guidelines; Prevention program; Primary Health Care; Process; Provider; Public Health; Randomized Controlled Trials; Recommendation; Reproducibility; Research Project Grants; Risk; Risk Factors; Survival Rate; Testing; Treatment Effectiveness; United States; Woman; arm; associated symptom; base; cancer health disparity; cancer prevention; chronic pain; experience; follow-up; gastric cancer prevention; health information technology; health literacy; high risk; improved; infection rate; malignant stomach neoplasm; medication compliance; men; mortality; patient oriented; programs; racial and ethnic; safety net; screening; theories; therapy design; tool; treatment adherence; treatment as usual; trial design

Project Summary/Abstract Stomach or gastric cancer is the fifth most common cancer and the third leading cause of cancer mortality in the world, with a disproportionate burden experienced among Asians globally and Asian Americans in the US. Stomach cancer incidence among Chinese Americans is nearly twice that of non-Hispanic whites. In New York City (NYC), Asian men have twice the stomach cancer mortality of non-Hispanic white men and Asian women have the highest rates across all racial/ethnic groups. The bacterium Helicobacter pylori (H. pylori) is the strongest risk factor for stomach cancer. Up to 75% of all stomach cancer cases in the US present with late- stage disease, underscoring the need for more prevention and early detection. H. pylori eradication through triple antibiotic therapy is the most effective prevention method, however, it requires patient education and provider support to yield high adherence, especially for limited English and low health literacy populations. Many patients at high risk for stomach cancer enter primary care and endoscopy clinics for dyspepsia symptoms associated with H. pylori, thus representing a key window for prevention. H. pylori eradication efforts in the US, however, are limited in practice and poorly integrated within health systems. Health information technology (HIT) and community health worker (CHW)-led interventions have demonstrated effectiveness in improving screening, treatment, and follow-up care to bridge this gap, yet no studies have investigated the impact of integrating these strategies into a test-and-treat H. pylori approach. Led by Dr. Simona Kwon, the study goal of this full Research Project is to assess the efficacy, adoption, and impact of an integrated intervention to improve adherence to recommended stomach cancer prevention guidelines for at-risk, limited English proficient, low-income Chinese Americans in NYC. The integrated multifaceted theory-based intervention involves: 1) a health systems-level intervention using electronic health record (EHR)-based tools to facilitate H. pylori test-and-treat strategies; and 2) a theory-informed culturally and linguistically adapted CHW-led patient navigation program. Using a two-arm randomized controlled trial design, we will enroll 144 Chinese American patients across NYC safety net hospital settings to achieve the following specific aims: 1) Collaboratively develop an EHR- based clinical decision support system and a CHW-led culturally and linguistically adapted stomach cancer prevention program to improve H. pylori eradication for the LEP, Chinese American patients; 2) Implement and assess the efficacy of a H. pylori test-and-treat EHR-CHW intervention; and 3) Use a mixed-methods approach and the RE-AIM evaluation framework to systematically assess the implementation process and delineate factors that influence feasibility, acceptability, adoption, sustainability, and scalability of a combined EHR-CHW strategy within safety net health care systems.

项目概要/摘要 胃癌是第五大常见癌症，也是癌症死亡的第三大原因 全球的亚洲人和美国的亚裔美国人承受着不成比例的负担。 华裔美国人的胃癌发病率几乎是非西班牙裔白人的两倍。在纽约 纽约市，亚裔男性的胃癌死亡率是非西班牙裔白人男性和亚裔女性的两倍 在所有种族/族裔群体中比率最高。幽门螺杆菌 (H. pylori) 是 胃癌的最强危险因素。在美国，高达 75% 的胃癌病例出现晚期癌症 疾病阶段，强调需要更多预防和早期发现。幽门螺杆菌根除 三联抗生素治疗是最有效的预防方法，但需要对患者进行教育和治疗 提供者支持以提高依从性，特别是对于英语水平有限和健康素养较低的人群。 许多胃癌高危患者因消化不良而进入初级保健和内窥镜诊所 与幽门螺杆菌相关的症状，因此代表了预防的关键窗口。幽门螺杆菌根除工作 然而，在美国，这种做法在实践中受到限制，并且与卫生系统的整合程度较差。健康资讯 技术（HIT）和社区卫生工作者（CHW）主导的干预措施已被证明是有效的 改善筛查、治疗和后续护理以弥补这一差距，但尚无研究调查 将这些策略整合到检测和治疗幽门螺杆菌方法中的影响。 由 Simona Kwon 博士领导，这个完整研究项目的研究目标是评估功效、采用率和 综合干预措施对提高对推荐的胃癌预防的依从性的影响 针对纽约市高危、英语水平有限、低收入的华裔美国人的指南。集成的 基于理论的多方面干预包括： 1) 使用电子健康进行卫生系统层面的干预 基于记录（EHR）的工具，以促进幽门螺杆菌检测和治疗策略； 2）具有丰富理论知识的文化和 语言适应的社区卫生工作者主导的患者导航程序。 采用双臂随机对照试验设计，我们将招募 144 名华裔美国患者 纽约市安全网医院设置旨在实现以下具体目标： 1) 合作开发 EHR- 基于临床决策支持系统和社区卫生工作者主导的文化和语言适应性胃癌 旨在提高美国华裔 LEP 患者幽门螺杆菌根除率的预防计划； 2) 实施并 评估幽门螺杆菌检测和治疗 EHR-CHW 干预措施的功效； 3) 使用混合方法 以及RE-AIM评估框架，系统评估实施过程并描绘 影响 EHR-CHW 组合的可行性、可接受性、采用性、可持续性和可扩展性的因素 安全网卫生保健系统内的战略。