Research Project 2

研究项目2

• 批准号: 9982105
• 负责人: Simona Kwon
• 金额: $ 33.13万
• 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/9982105
• 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.

项目摘要/摘要 在#年，胃癌是第五大常见癌症，是导致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/民族中，这一比例最高。幽门螺杆菌(H.ylori)是 胃癌的最大危险因素。在美国，高达75%的胃癌病例表现为晚期- 疾病阶段，强调需要更多的预防和早期发现。通过根除幽门螺杆菌 抗生素三联疗法是最有效的预防方法，但它需要患者教育和 提供者提供支持以实现高依从性，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，因此是预防的关键窗口。根除幽门螺杆菌努力 然而，在美国，这些措施在实践中受到限制，而且在卫生系统中的整合程度很低。健康信息 技术(HIT)和社区卫生工作者(CHW)领导的干预措施在 改善筛查、治疗和后续护理以弥补这一差距，但尚未有研究调查 将这些策略整合到检测和治疗幽门螺杆菌的方法中的影响。 在Simona Kuan博士的带领下，这项完整研究项目的研究目标是评估有效性、采用率和 综合干预对提高对推荐的胃癌预防措施的依从性的影响 纽约市低收入、英语水平有限的高危华裔美国人指南。集成的 基于多方面理论的干预包括：1)使用电子健康的卫生系统级别的干预 以记录(EHR)为基础的工具，以促进幽门螺杆菌的检测和治疗策略；和2)从理论上了解文化和 语言改编的CHW主导的患者导航计划。 采用双臂随机对照试验设计，我们将纳入144名华裔美国患者。 纽约市安全网医院设置以实现以下具体目标：1)合作开发EHR- 基于临床决策支持系统和CHW主导的文化和语言适应的胃癌 改善LEP、华裔美国患者根除幽门螺杆菌的预防计划；2)实施和 评估幽门螺杆菌检测和治疗EHR-CHW干预的有效性；以及3)使用混合方法 和RE-AIM评价框架，以系统地评估执行进程并划定 影响EHR-CHW组合的可行性、可接受性、采用率、可持续性和可扩展性的因素 在安全网卫生保健系统内的战略。