Patient Navigation 2.0: Addressing the Challenge of Scaling Navigation through Checklist-based Implementation

患者导航 2.0：通过基于清单的实施应对扩展导航的挑战

基本信息

批准号：
10680367
负责人：
MELISSA A. SIMON
金额：
$ 52.05万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-03-15 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10680367
关键词：
Accountability Address Adult Area Behavioral Cancer Patient Caring Chicago Chinese Chinese American Climate Clinical Collaborations Communities Community Clinical Oncology Program Community Health Community Participation Consolidated Framework for Implementation Research Cost Analysis Counseling Diagnostic Funding Health Health system Healthcare Systems Hospitals Human Papillomavirus Hybrids Immigrant Immigrant community Immunization Institution Intervention Interview Learning Linguistics Malignant Neoplasms Malignant neoplasm of cervix uteri Mammographic screening Medical center Methods Midwestern United States Modeling Organizational Change Organizational Culture Participant Patients Population Preventive service Randomized Recommendation Research Research Personnel Resolution Resources Screening for cancer Screening procedure Service setting Services Social Work Surveys System Testing Thinking Time Underserved Population United States Preventative Services Task Force Universities Work barrier to care cancer care care delivery compare effectiveness design effectiveness/implementation trial evidence base follow-up implementation evaluation implementation strategy implementation/effectiveness improved malignant breast neoplasm medically underserved medically underserved population member organizational readiness participant enrollment patient navigation patient-level barriers payment post intervention pragmatic trial primary outcome process evaluation programs prototype randomized trial recruit safety net screening secondary outcome service providers social social health determinants

项目摘要

Through the work of a well-established research partnership among the Chinese American Service League (CASL), Mercy Hospital & Medical Center (Mercy), and Northwestern University (NU), our team completed a trial evaluating a one-on-one patient navigation (PN) intervention for breast and cervical cancer tailored to Chicago’s Chinatown. Our completed trial and others have demonstrated that PN is effective in improving consistency of cancer care and addressing Social Determinants of Health (SDoH) among underserved populations. Unfortunately, current standard one-on-one PN is difficult to scale and sustain without intensive financial resources, which limits one-on-one cancer PN to a temporary “Band-Aid” for fragmented healthcare systems. We have an opportunity to apply our team’s lessons learned from our completed PN trial in order to create a paradigm shift in PN to produce systems change in cancer care delivery to meet the needs of underserved populations. To do so, we propose a learning health system PN 2.0 Checklist implementation strategy that scales implementation of PN across cancers and builds a sustainable team-based checklist that will support coordination and integration of SDoH-related efforts across community oncology and community social service settings. In Aim 1, we will employ a design-thinking framework of co-creation and iterative prototyping to develop the PN 2.0 Checklist, transforming one-on-one PN into a learning health system PN approach centered around a team-based checklist that leverages the PN evidence base and active participation of community oncology and community social service stakeholders. In Aim 2, through a Hybrid Type 2 randomized effectiveness- implementation pragmatic trial, we will compare the effectiveness (non-inferiority) of the PN 2.0 Checklist relative to one-on-one PN in resolving SDoH barriers and increasing patient receipt of clinical cancer preventive services. N=600 Chinese adults recruited from Chicago’s Chinatown will be randomized to standard one-on-one cancer PN (control) or cancer PN 2.0 Checklist (intervention). The primary outcome is an adjusted, composite proportion of SDoH barriers resolved and completion of U.S. Preventive Services Task Force recommended cancer-related screenings, behavioral counseling, and immunizations, collected via chart review and patient surveys. We will explore the effect of the PN 2.0 Checklist on organizational change and patient assessment of care team quality using pre/post surveys. Secondary outcomes include time to diagnostic resolution and time to treatment initiation. In Aim 3, we will use the Consolidated Framework for Implementation Research (CFIR) and mixed-methods (process evaluation, qualitative interviews, cost analysis) to evaluate the implementation of the learning health system PN 2.0 Checklist strategy. Results will have important implications for implementation, sustainability, and scaling of PN in community oncology settings where medically underserved U.S. immigrant populations, such as linguistically isolated Chinese, receive the bulk of their cancer care.

通过在美国美国服务联盟建立了公认的研究合作伙伴关系的工作（CASL），Mercy医院和医疗中心（Mercy）和西北大学（NU），我们的团队完成了试验评估针对芝加哥的乳腺癌和宫颈癌一对一的患者导航（PN）干预措施唐人街。我们完成的审判，其他人则证明PN有效地提高了一致性在服务不足的人群中，癌症护理和卫生社会决定因素（SDOH）。不幸的是，目前的一对一PN难以扩展和维持，而没有密集的财务资源将一对一的癌症PN限制为零散的医疗系统的临时“创可贴”。我们有机会应用团队从完成的PN试验中学到的教训，以创建一个 PN的范式转移以产生癌症护理输送的系统变化，以满足服务不足的需求人群。为此，我们建议学习健康系统PN 2.0清单实施策略，范围范围内PN的量表实施，并建立一个可持续的基于团队的清单，将支持在社区肿瘤学和社区社会服务中与SDOH相关的努力的协调和整合设置。在AIM 1中，我们将采用共同创造和迭代原型设计的设计思维框架 PN 2.0清单，将一对一的PN转换为学习卫生系统PN方法的中心一个基于团队的清单，利用PN证据基础和社区肿瘤学的积极参与和社区社会服务利益相关者。在AIM 2中，通过混合2型随机有效性 - 实施实用试验，我们将比较PN 2.0清单的有效性（非效率）相对于解决SDOH屏障和患者收到临床癌预防的一对一PN 服务。 n =从芝加哥唐人街招募的600名中国成年人将随机分为一对一的标准癌症PN（对照）或癌症PN 2.0清单（干预）。主要结果是调整后的复合材料建议解决和完成美国预防服务工作队的SDOH屏障比例通过图表审查和患者收集的与癌症相关的筛查，行为咨询和免疫抑制调查。我们将探讨PN 2.0清单对组织变革和患者评估的影响使用预/后调查的护理团队质量。次要结果包括诊断分辨率的时间和时间治疗计划。在AIM 3中，我们将使用合并框架进行实施研究（CFIR）和混合方法（过程评估，定性访谈，成本分析）评估实施学习卫生系统PN 2.0清单策略。结果将对实施具有重要意义，可持续性和在社区肿瘤学环境中的PN缩放，在那里医疗服务不足的美国移民人口（例如语言孤立的中国人）接受了大部分癌症护理。