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.

项目总结/摘要 胃癌是世界上第五大最常见的癌症，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 在纽约市，亚裔男性的胃癌死亡率是非西班牙裔白色男性和亚裔女性的两倍 在所有种族/族裔群体中的发病率最高。幽门螺杆菌（Helicobacter pylori，H. pylori）是 胃癌的最大危险因素。在美国，高达75%的胃癌病例出现晚期- 疾病的早期阶段，强调需要更多的预防和早期发现。H.幽门螺杆菌根除 三联抗生素治疗是最有效的预防方法，然而，它需要患者教育， 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检查诊所 与H. pylori，因此是预防的关键窗口。H.根除幽门的努力 然而，在美国，这种方法在实践中受到限制，而且与卫生系统的整合程度很差。健康信息 技术（HIT）和社区卫生工作者（CHW）主导的干预措施已证明在以下方面有效： 改善筛查、治疗和随访护理以弥补这一差距，但还没有研究调查 将这些策略整合到测试和治疗H中的影响。pylori方法。 由Simona Kwon博士领导，该完整研究项目的研究目标是评估疗效，采用率和 综合干预对提高胃癌预防依从性的影响 为纽约市有风险、英语水平有限、低收入的华裔美国人提供指导。集成 基于多方面理论的干预包括：1）使用电子健康的健康系统级干预 记录（EHR）为基础的工具，以促进H。幽门螺杆菌测试和治疗策略;和2）理论知情的文化和 语言适应CHW领导的患者导航程序。 采用两组随机对照试验设计，我们将招募144名美国华裔患者， 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领导的文化和语言适应性胃癌 预防计划，以改善H.幽门螺杆菌根除的LEP，华裔美国患者; 2）实施和 评估H. pylori检测和治疗EHR-CHW干预; 3）使用混合方法 和RE-AIM评估框架，以系统地评估实施过程， 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 安全网保健系统内的战略。