Administrative Supplements for the Implementation Science Centers in Cancer Control (ISC3): Advancing Health Equity through Implementation Science

癌症控制实施科学中心 (ISC3) 的行政补充：通过实施科学促进健康公平

• 批准号: 10727614
• 负责人: Sarah LeLeiko Cutrona
• 金额: $ 12.5万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-18 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10727614
• 关键词: Address; Administrative Supplement; Adoption; Cancer Control; Cancer health equity; Caring; Clinic; Clinical; Collaborations; Data; Documentation; Electronic Health Record; Equity; Financial Hardship; Goals; Health; Housing; Incidence; Individual; Inequity; Interview; Malignant Neoplasms; Measurement; Measures; Morbidity - disease rate; Oncology; Outcome; Patient-Focused Outcomes; Patients; Phase; Pilot Projects; Population; Provider; Randomized, Controlled Trials; Risk; Risk Factors; Screening procedure; Shapes; Structure; Testing; Transportation; cancer care; cancer therapy; evidence base; experience; food insecurity; forest; health equity; health inequalities; implementation science; implementation strategy; implementation study; improved; informant; mortality; screening; social; social health determinants

Project Summary Social determinants of health (SDOH), social risk factors, and unmet social needs have critical implications for shaping and exacerbating health and health inequities for cancer incidence, morbidity and mortality. There is a critical need for accurate and comprehensive approaches to understanding how SDOH impact the implementation of evidence-based cancer care, equitable cancer outcomes, and health equity. Reliable, widespread, and available measurement of individual-level SDOH for all patients is a critical first step in identifying those patients at greater risk for experiencing inequities and that have unmet social needs. In our Phase I ISC3 Administrative Supplement for Advancing Health Equity through Implementation Science, Wake Forest iDAPT ISC3 and Penn ISC3 collaborated to evaluate the recent deployment of an electronic health record (EHR) module called the Epic® SDOH Wheel (herein “the Wheel”). The Wheel includes 16 items (e.g., food insecurity, transportation needs, housing, financial strain) that address social risk factors and unmet social needs. Phase I was a pre-implementation study to document current rates of SDOH screening and identify gaps in delivery, to inform strategies for increasing equitable reach of SDOH screening. We found markedly low rates of adoption of SDOH screening by oncology care teams and limited reach to oncology patients. Nonetheless, our key informant interviews revealed a commitment to measuring and addressing SDOH by the oncology care teams and clinical leaders, as well as context-specific SDOH screening tools that oncology care teams used instead of the Wheel. Findings from Phase 1 inform our proposed Phase 2 implementation pilot study to increase SDOH screening in patients undergoing cancer treatment at our Centers. Specifically, in Aim 1, we will develop tailored implementation strategies for increasing reach, equity, and adoption of SDOH screening in patients with cancer across a diverse range of cancer care settings and populations through rigorous rapid assessment of oncology care teams’ setting in the proposed clinics); adaptation of existing SDOH screening tools, and identification of implementation strategies to increase timely and widespread assessment and documentation of SDOH screening in patients with cancer. In Aim 2, we will assess the impact of tailored implementation strategies on reach, equity, and adoption of SDOH screening in patients with cancer using electronic health record data. We will use semi-structured interviews to understand factors influencing reach, equity, and adoption of SDOH screening from the perspective of patients, providers and staff. We will use findings from the proposed study to develop an R01 application for a randomized controlled trial to test the effect of CD2 on SDOH screening reach, equity, and adoption and subsequent efforts to address persistent or emergent social needs with the overarching goal of optimizing patient outcomes and improving cancer health equity.

项目概要 健康的社会决定因素 (SDOH)、社会风险因素和未满足的社会需求对 形成并加剧癌症发病率、发病率和死亡率的健康和卫生不平等。有一个 迫切需要准确和全面的方法来了解 SDOH 如何影响 实施循证癌症护理、公平的癌症结果和健康公平。可靠的， 对所有患者进行广泛且可用的个体水平 SDOH 测量是关键的第一步 识别那些面临更大风险遭受不平等且社会需求未得到满足的患者。在我们的 第一阶段 ISC3 通过实施科学促进健康公平的行政补充，Wake Forest iDAPT ISC3 和 Penn ISC3 合作评估电子健康记录的最新部署 (EHR) 模块称为 Epic® SDOH 轮（以下简称“轮”）。轮子包括 16 个项目（例如食物 不安全、交通需求、住房、财务压力），解决社会风险因素和未满足的社会需求 需要。第一阶段是一项实施前研究，旨在记录当前的 SDOH 筛查率并找出差距 在实施过程中，为扩大 SDOH 筛查的公平覆盖范围提供策略信息。我们发现利率明显较低 肿瘤护理团队采用 SDOH 筛查，但对肿瘤患者的覆盖范围有限。尽管如此， 我们的关键知情人访谈揭示了通过肿瘤护理衡量和解决 SDOH 的承诺 团队和临床领导者，以及肿瘤护理团队使用的针对具体情况的 SDOH 筛查工具 而不是轮子。第一阶段的调查结果为我们拟议的第二阶段实施试点研究提供了信息，以增加 对在我们中心接受癌症治疗的患者进行 SDOH 筛查。具体来说，在目标 1 中，我们将开发 量身定制的实施策略，以扩大 SDOH 筛查的覆盖面、公平性和采用率 通过严格的快速评估，在不同的癌症护理环境和人群中进行癌症治疗 拟议诊所的肿瘤护理团队设置）；调整现有的 SDOH 筛查工具，以及 确定实施战略，以加强及时、广泛的评估和记录 癌症患者的 SDOH 筛查。在目标 2 中，我们将评估量身定制的实施策略的影响 使用电子健康记录数据对癌症患者进行 SDOH 筛查的范围、公平性和采用情况。 我们将使用半结构化访谈来了解影响 SDOH 的覆盖范围、公平性和采用的因素 从患者、提供者和工作人员的角度进行筛查。我们将利用拟议研究的结果来 开发 R01 应用程序进行随机对照试验，以测试 CD2 对 SDOH 筛查范围的影响， 公平、采用和随后的努力，以解决持续或紧急的社会需求 优化患者治疗结果和改善癌症健康公平的目标。