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

项目摘要 医院越来越多地合并为共享所有权和管理权的卫生系统。照料 卫生系统对手术癌症患者有潜在的好处，包括改善获得，护理协调， 在整个系统中心传播和实施迅速发展的循证基础并付诸实践的战略 和辐条站点。先前的研究表明，这些潜在的好处仍然难以捉摸。的影响 对质量的巩固差异很大，对于接受手术治疗的癌症患者， 同一系统中的不同设施。我们已经表明，手术治疗癌症的位置决定了是否 采取有效的治疗方法（实施）或停止无效的治疗方法（取消） 执行）。我们假设卫生系统的特征和策略与变异性有关 在中心和辐射医院之间实施肿瘤学证据， 根据观察到的差异，我们将确定有针对性的多层次干预措施的杠杆。 这项工作解决了NIH蓝图的目标，即通过确保采用 实践和目标农村个人，一个人口与不同的医疗保健服务和结果，谁是 经常在辐条医院接受治疗我们将研究医疗系统中常见癌症治疗的影响 通过将SEER-Medicare数据与 卫生系统数据。然后，我们将确定与证据相关的卫生系统特征 实施，无论是定量使用多层次建模和定性通过结构化访谈， 卫生系统的利益相关者。最后，我们将利用我们的大学卫生系统内的资源， 亚拉巴马大学伯明翰分校（UAB）制定系统一级的干预措施， 肿瘤学证据跨中心和辐射部位。 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 证据通过这个培训奖，我将补充我的健康服务和质量改进科学 在医疗保健提供组织方面接受过高级培训的专业知识，二级数据的多级分析， 和实施科学，以制定系统级干预措施，改善循证外科癌症 在乎

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.