Leveraging Health Systems to Increase Implementation of Evidence-based Surgical Cancer Care

项目总结 医院越来越多地整合为共享所有权和管理的卫生系统。护理在一家医院 卫生系统对外科癌症患者具有潜在的好处，包括改善获得机会、护理协调、 和战略，以传播和实施迅速发展的证据基础，并在整个系统中心付诸实践 和发言网站。先前的研究表明，这些潜在的好处仍然难以捉摸。网络的影响 质量上的巩固差异很大，手术治疗的癌症患者的结果也不同 同一系统中的不同设施。我们已经证明，外科癌症护理的地点决定了 有效的治疗被采用(实施)或无效的治疗被终止(停止 实施)。我们假设卫生系统的特征和策略与可变性有关 在星型医院开展肿瘤学证据工作中的作用 观察到的差异我们将确定有针对性的、多水平干预的杠杆。 这项工作解决了NIH蓝图的目标，即通过确保采用 实践和目标是农村个人，这是一个拥有不同医疗保健机会和结果的人群，他们是 通常在分支医院接受治疗。我们将研究常见癌症的治疗在卫生系统中的影响 通过将SEER-Medicare数据与 健康系统数据。然后，我们将确定与证据相关联的卫生系统特征 实施，既使用多级别建模进行定量，也通过结构化访谈 卫生系统利益攸关方。最后，我们将使用我们在加州大学的卫生系统内的资源 阿拉巴马州伯明翰分校(UAB)制定系统级干预措施，以传播和实施 中枢和辐射区的肿瘤学证据。 我的长期目标是成为一名独立的调查员，通过以下方式提高癌症护理服务的质量 设计、实施和研究卫生系统层面的干预措施以增加肿瘤学的临床采用率 证据。通过这个培训奖项，我将补充我的健康服务和质量改进科学 具备医疗保健提供组织、二级数据多层次分析、 和实施科学，开发系统级别的干预措施，以改善循证外科癌症 关心。

PROJECT SUMMARY Hospitals are increasingly consolidating into health systems with shared ownership and management. Care in a health system has potential benefits for surgical cancer patients including improved access, care coordination, and strategies to disseminate and implement a rapidly evolving evidence-base into practice across system hub and spoke sites. Prior research has demonstrated that these potential benefits remain elusive. The impact of consolidation on quality varies widely, and there are disparate outcomes for surgical cancer patients treated at different facilities in the same systems. We have shown that location of surgical cancer care determines whether effective treatments are adopted (implementation) or ineffective treatments discontinued (de- implementation). We hypothesize that health system characteristics and strategies are associated with variability in implementation of oncologic evidence among hub and spoke hospitals and that through exploration of observed differences we will identify levers for targeted, multi-level interventions. This work addresses the NIH Blueprint objective to enhance research investments by ensuring adoption into practice and targets rural individuals, a population with disparate healthcare access and outcomes, who are often treated at spoke hospitals. We will examine the influence of treatment for common cancers in health system hubs and spokes on patient access and receipt of evidence-based care by linking SEER-Medicare data with health system data. Then, we will identify health system characteristics associated with evidence implementation, both quantitatively using multilevel modeling and qualitatively through structured interviews with health system stakeholders. Finally, we will use the resources within our Health System at the University of Alabama at Birmingham (UAB) to develop a system-level intervention for dissemination and implementation of oncologic evidence across hub and spoke sites. My long-term goal is to become an independent investigator who improves the quality of cancer care delivery by designing, implementing and studying health system-level interventions to increase clinical adoption of oncologic evidence. Through this training award, I will complement my health services and quality improvement science expertise with advanced training in the organization of healthcare delivery, multilevel analysis of secondary data, and implementation science to develop a system-level intervention to improve evidence-based surgical cancer care.