Effectiveness and implementation of a health system intervention to improve quality of cancer care for rural, underserved patients

卫生系统干预措施的有效性和实施，以提高农村、服务不足的患者的癌症护理质量

• 批准号: 10381455
• 负责人: MARY E. CHARLTON
• 金额: $ 60.04万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10381455
• 关键词: Accreditation; Address; Adopted; Adoption; American College of Surgeons; Area; Breast; Breast-Conserving Surgery; Cancer Center; Cancer Death Rates; Cancer Patient; Caring; Colon Carcinoma; Colorectal; Colorectal Cancer; Community Hospitals; Consolidated Framework for Implementation Research; Data; Data Collection; Diagnosis; Diffusion; Effectiveness; Familiarity; Goals; Guidelines; Health system; Healthcare; Home; Hospitals; Incidence; Infrastructure; Intervention; Intervention Trial; Interview; Iowa; Kentucky; Lead; Logistics; Malignant Neoplasms; Measures; Methods; Modeling; Monitor; Needs Assessment; Outcome; Patients; Pattern; Performance; Physicians; Population; Proctor framework; Quality of Care; Radiation therapy; Readiness; Research; Resected; Resource Sharing; Resources; Risk; Rural; Rural Hospitals; Rural Population; Services; Social support; Specialist; Specific qualifier value; Structure; Testing; Time; Transportation; United States; Universities; Urban Population; Woman; Work; adaptation algorithm; base; breast cancer diagnosis; cancer care; cancer health disparity; cancer therapy; cancer type; care outcomes; cost; data registry; draining lymph node; evidence base; implementation determinants; implementation outcomes; implementation process; implementation science; improved; malignant breast neoplasm; mortality; multidisciplinary; neoplasm registry; network models; novel; post intervention; preference; preservation; programs; psychosocial; rural area; rural cancer care; rural disparities; rural dwellers; rural patients; rural setting; rural underserved; survival outcome; survivorship; theories; tool; treatment guidelines; treatment planning

PROJECT SUMMARY There is growing evidence that limited access to high-quality cancer treatment is one of the main drivers of higher cancer mortality rates among rural cancer patients. Our analyses of Iowa Cancer Registry data indicate that 40% of rural patients with breast and colorectal cancers receive most or all definitive treatment in rural hospitals that do not collect or monitor data on their quality of cancer care, and are not accredited by the American College of Surgeons Commission on Cancer (CoC). Our data also shows these patients are less likely to receive guideline-concordant care. Given patients' needs and preferences to receive cancer care locally, a promising strategy to improve quality of cancer care and outcomes in rural populations is to intervene directly with the community hospitals in these areas. New evidence has demonstrated effectiveness of this approach: the Markey Cancer Center Affiliate Network (MCCAN) was formed by the University of Kentucky (UK) Markey Cancer Center to improve quality of cancer care in their own rural, low-resourced state, one that leads the nation in cancer incidence and mortality. Over the last decade MCCAN has facilitated the sharing and diffusion of resources and best practices throughout their network. As a result, affiliates markedly improved performance on established, cancer care quality measures and expanded their services (e.g., psychosocial and survivorship support). They were also almost 3 times more likely to obtain CoC accreditation than their matched controls. However, the MCCAN model has not been rigorously defined, evaluated or tested in any other setting. We propose to adapt this successful health system-level intervention for Iowa, establishing the Iowa Cancer Affiliate Network (I-CAN). Although there are similarities between Iowa and Kentucky's populations that suggest the MCCAN model may be a good fit, there are also significant differences in healthcare infrastructure and resources that require careful adaptation of the intervention prior to its implementation in order to retain its effectiveness. We will use novel, rigorously developed, theory-based implementation science methods to identify MCCAN's core functions (i.e., what makes it effective), study the implementation process and evaluate how I-CAN performs in a new context. We have identified 4 rural, Iowa hospitals to participate in this intervention trial and developed expert support teams to assist key stakeholder groups within each hospital. Through interviews and qualitative analyses, we will assess determinants and outcomes of the implementation process, and perceived value of the CoC accreditation standards and the intervention itself as a way to improve the quality of cancer care for their patients. We will compare compliance with treatment-related quality measures and the proportion of CoC standards of cancer care implemented in target and control hospitals, pre- and post-intervention using a difference-in-difference estimator. This work could lead to dissemination of similar models across rural settings thereby improving quality of care, reducing rural disparities in cancer outcomes and giving rural hospitals an avenue to demonstrate their quality of care.

项目摘要 越来越多的证据表明，获得高质量癌症治疗的机会有限是癌症患者死亡的主要驱动因素之一。 农村癌症患者的癌症死亡率较高。我们对爱荷华州癌症登记数据的分析表明， 40%的农村乳腺癌和结直肠癌患者在农村接受了大部分或全部的确定性治疗， 医院不收集或监测其癌症护理质量的数据，也没有得到 美国外科医生学会癌症委员会（CoC）我们的数据还显示，这些患者 有可能接受符合指南的护理。考虑到患者接受癌症护理的需求和偏好 在当地，一个有希望的战略，以提高癌症护理质量和结果，在农村人口是干预 直接与这些地区的社区医院联系。新的证据证明了这一点的有效性。 方法：由肯塔基州大学建立的马基癌症中心附属网络（MCCAN） (UK)马基癌症中心，以提高癌症护理的质量，在自己的农村，低资源的状态，一个， 在癌症发病率和死亡率方面居全国首位。在过去的十年里，MCCAN促进了共享 在整个网络中传播资源和最佳做法。因此，附属机构明显 提高既定的癌症护理质量指标的绩效，并扩大其服务（例如， 心理和生存支持）。他们获得CoC认证的可能性也高出近3倍 相比较的对照组。然而，MCCAN模型尚未得到严格的定义、评估或测试 在任何其他设置。我们建议将这一成功的卫生系统级干预措施适用于爱荷华州， 爱荷华州癌症联盟网络（I-CAN）。尽管爱荷华州和肯塔基州的 表明MCCAN模型可能是一个很好的拟合的人群，也有显着差异， 医疗保健基础设施和资源，需要仔细调整干预之前， 以保持其有效性。我们将使用新颖的，严格开发的，基于理论的 实施科学方法，以确定MCCAN的核心功能（即，是什么使它有效），研究 实施过程中，并评估如何I-CAN在新的情况下执行。我们已经确定了4个乡村，爱荷华州 医院参与这项干预试验，并建立了专家支持团队，以协助关键利益相关者 每个医院内都有。通过访谈和定性分析，我们将评估决定因素， 实施过程的结果，以及CoC认证标准和 干预本身作为一种提高癌症患者护理质量的方法。我们将比较合规性 与治疗相关的质量措施和癌症护理CoC标准的比例， 目标医院和对照医院，干预前和干预后使用差异中的差异估计。这项工作 可以在农村地区推广类似的模式，从而提高护理质量， 农村地区在癌症治疗结果方面的差异，并为农村医院提供展示其护理质量的途径。