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

项目摘要 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以下方面具有重要影响： 在癌症发病率、发病率和死亡率方面形成和加剧卫生和卫生不平等现象。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， 对所有患者的个体水平SDOH进行广泛和可用的测量是关键的第一步， 识别那些面临更大风险的患者，以体验不公平和未满足的社会需求。在我们 第一阶段ISC 3通过实施科学促进健康公平的行政补充，威克 Forest iDAPT ISC 3和Penn ISC 3合作评估了最近部署的电子健康记录 (EHR)该模块被称为Epic® SDOH轮（在本文中称为“轮”）。该轮包括16个项目（例如，食品 不安全、交通需要、住房、财政紧张），解决社会风险因素和未得到满足的社会需求， 需求第一阶段是实施前研究，记录目前的SDOH筛查率，并找出差距 在实施过程中，为增加SDOH筛查公平覆盖率的战略提供信息。我们发现， 肿瘤护理团队采用SDOH筛查，对肿瘤患者的覆盖范围有限。尽管如此， 我们的关键线人访谈显示，肿瘤护理致力于衡量和解决SDOH， 团队和临床领导者，以及肿瘤护理团队使用的特定背景的SDOH筛选工具 而不是车轮。第1阶段的调查结果为我们拟议的第2阶段实施试点研究提供了信息， 在我们中心接受癌症治疗的患者中进行SDOH筛查。具体而言，在目标1中，我们将开发 定制实施策略，以增加患者的SDOH筛查覆盖范围，公平性和采用率 通过严格的快速评估， 肿瘤护理团队在拟议诊所中的设置）;调整现有的SDOH筛查工具，以及 确定执行战略，以加强对 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战略的影响 使用电子健康记录数据对癌症患者进行SDOH筛查的可及性、公平性和采用性。 我们将使用半结构化访谈来了解影响SDOH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。我们会利用拟议研究的结果， 为随机对照试验开发R 01应用程序，以测试CD 2对SDOH筛查范围的影响， 公平，以及采用和随后的努力，以解决持续或紧急的社会需求， 目标是优化患者的治疗结果，改善癌症健康公平性。

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.