Designing a Plan of Action for Better Access and Quality of Surgery for African-Americans with Gastrointestinal Cancers in the Deep South

目前的证据表明，患有胃肠道(GI)癌症的非裔美国人(AA)(结直肠癌、胰腺癌和 食道癌)不太可能接受手术，这表明那些接受手术的人可能不太可能 及时接受最佳证据的外科治疗，并将不良手术结果降至最低。消除这些问题的努力 种族/民族差异是合理的，特别是在阿拉巴马州和密西西比州。美国深渊的这两个州 南方的胃肠癌发病率和死亡率很高，特别是再生障碍性贫血的死亡率很高，再生障碍性贫血人口众多，以及 获得优质医疗服务面临的挑战，例如负担能力和可获得性有限。既没有外科护理的差异，也没有 在这些状态下，他们的驱动机制已经得到了检验。此外，铺设导航和增强恢复后 外科手术(ERAS)是建立消除手术差异计划的有效模式。在我们的机构里， 实施电子逆向拍卖程序，消除了外科手术住院时间的差异。 危及手术结果。我们的长期目标是最终消除在胃肠道癌症手术护理方面的差距 通过改善获得及时手术的机会和促进在AL和MS中采用电子逆向拍卖，我们的目标是： 1)通过对450名AA和550名白人GI癌症患者的调查，找出AL和MS在GI癌症手术治疗方面的差距， 和医疗图表摘要，我们将评估AA和白人在i)接受手术，ii)时间从 诊断到手术，以及iii)暴露在17个ERA过程中；2)检查手术差异的潜在机制。 将调查结果与对48名AA和白人患者以及48名GI癌症护理人员的个人访谈结果相结合 提供者在一种混合方法的综合分析中，我们将提供对患者、提供者和 影响获得护理机制的系统层面因素，即手术护理和电子逆向拍卖程序是否可接受； 负担得起、可获得、可接近和可容纳的；3)评估以手术为重点的联合铺设的可行性 导航和ERAS干预在胃肠道癌症中的应用。AIMS 1和AIMS 2的结果将指导以手术为重点的 导航器计划，以促进获得及时的手术，并支持患者在围手术期到术后阶段。通过 为了实现目标1-3，我们将确定：i)AL和MS中GI癌症患者未来的干预目标，即， 人口和手术程序；二)为实现有效的手术护理而应采取的机制；三)a 以手术为中心的导航计划，以优化外科手术的摄取和实施AAS的ERAS。因此， 该项目的预期结果是一项具体和详细的可操作计划，以消除AL和 在没有这一重大新知识的情况下，在消除胃肠道癌症手术差异方面取得的进展是 受阻了。有了这个计划，我们将为实现我们的目标做好充分的准备，并对我们的目标产生重大影响 国家少数民族健康和健康差距研究所(NIMHD)和国家癌症研究所(NCI)将推进 科学知识将帮助所有人活得更长、更健康，并消除健康差距。

Current evidence shows that African-Americans (AAs) with gastrointestinal (GI) cancers (colorectal, pancreatic and esophageal cancer) are less likely to undergo surgery, and suggests that those who undergo surgery may be less likely to receive best-evidence surgical care that is timely and minimizes adverse surgical outcomes. An effort to eliminate these racial/ethnic disparities is warranted especially in Alabama (AL) and Mississippi (MS). These two states of the US Deep South have high GI cancer incidence and mortality, and high mortality for AAs in particular, large AA populations, and challenges for access to quality care such as limited affordability and availability. Neither surgical care disparities nor their driving mechanisms have been examined in these states. In addition, lay navigation and Enhanced Recovery After Surgery (ERAS) are effective models on which to build a plan to eliminate surgical disparities. At our institution, the implementation of ERAS processes has led to the elimination of surgical disparities in length of stay without compromising surgical outcomes. Our long term objective is to ultimately eliminate disparities in GI cancer surgery care and outcomes by improving access to timely surgery and facilitating the adoption of ERAS in AL and MS. Our aims are to: 1) Identify gaps in surgical care for GI cancers in AL and MS. With a survey of 450 AA and 550 white GI cancer patients, and medical chart abstraction, we will assess differences for AAs and whites in i) receipt of surgery, ii) time from diagnosis to surgery, and iii) exposure to 17 ERAS processes; 2) Examine potential mechanisms of surgical disparities. Combining survey results with those of individual interviews with 48 AA and white patients and with 48 GI cancer care providers in a mixed methods integrated analysis, we will provide a comprehensive assessment of patient, provider, and system level factors that affect access to care mechanisms, i.e., whether surgery care and ERAS processes are acceptable, affordable, available, accessible and accommodating; 3) Assess the feasibility of a combined surgery-focused lay navigation and ERAS intervention in GI cancer. Results from Aims 1 an 2 will guide the development of a surgery-focused navigator program to facilitate access to timely surgery and support patients in the peri- to post- surgery phases. By accomplishing Aims 1-3, we will define: i) future intervention targets for GI cancer patients in AL and MS, i.e., populations and surgery processes; ii) mechanisms to address in order to achieve effective surgical care; and iii) a surgery focused navigation program to optimize the uptake of surgery and implementation of ERAS for AAs. Thus, the expected outcome of this project is a concrete and detailed actionable plan to eliminate surgical disparities in AL and MS. Without this significant new knowledge, progress toward the elimination of disparities in GI cancer surgery is hindered. With this plan, we will be well prepared to achieve our objective and have a high impact on the goals of the National Institute on Minority Health and Health Disparities (NIMHD) and the National Cancer Institute (NCI) to advance scientific knowledge that will help all people live longer, healthier lives, and eliminate health disparities.