Implementing Risk-aligned Bladder Cancer Surveillance

实施风险调整的膀胱癌监测

• 批准号: 10792860
• 负责人: Florian R Schroeck
• 金额: --
• 依托单位: WHITE RIVER JUNCTION VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10792860
• 关键词: Address; Adoption; Affect; Algorithms; Anxiety; Area; Bladder; Caring; Chronic Disease; Classification; Clinical Trials; Cluster randomized trial; Code; Consensus; Cystoscopy; Data; Data Set; Diagnosis; Effectiveness; Electronic Health Record; Family; Feedback; Foundations; Frequencies; Frontline worker; Goals; Habits; Healthcare Systems; International; Interview; Knowledge; Lead; Leadership; Malignant Neoplasms; Malignant neoplasm of urinary bladder; Maps; Measures; Methods; Monitor; Muscle; Natural Language Processing; Nurses; Operative Surgical Procedures; Patient risk; Patients; Patterns of Care; Physicians; Pilot Projects; Procedures; Process; Provider; Recurrence; Recurrent disease; Research; Risk; Site; Specific qualifier value; Structure; Surveys; Telephone; Testing; United States Department of Veterans Affairs; Unnecessary Procedures; Veterans; Work; cancer invasiveness; cancer type; care systems; clinical practice; cost; disorder risk; high risk; implementation measures; implementation outcomes; implementation science; implementation strategy; implementation trial; improved; intervention mapping; mortality; pilot test; provider-level barriers; recruit

Patients with early stage bladder cancer undergo frequent surveillance cystoscopy procedures where a camera is inserted into the bladder to detect disease recurrence. This makes cystoscopy the most common surgical procedure in the Department of Veterans Affairs (VA) with 30,000 procedures performed annually. There is international consensus that surveillance for early stage bladder cancer should be aligned with each patient’s risk for recurrence and progression. Risk-aligned surveillance entails cystoscopy every year for low- risk early stage bladder cancer and three times a year for high-risk early stage bladder cancer. However, risk-aligned surveillance rarely occurs. In our prior work, we found that 75% of low-risk patients had too much surveillance. Similarly, we found that 31% of high-risk patients had not enough surveillance. Overuse among low-risk patients is undesirable, because unnecessary cystoscopy procedures lead to more discomfort, anxiety, and costs. Underuse among high-risk patients is worrisome, because it puts them at risk for delayed diagnosis of muscle-invasive cancer, which is associated with increased mortality. We also classified VA facilities according to their patterns of care and found that risk-aligned surveillance was rare, with 70 of 85 facilities performing surveillance at a similar frequency for low- and high-risk patients. Little is known about the patient, provider, and facility factors that promote risk-aligned surveillance. Thus, there is a critical need to understand determinants of risk-aligned surveillance and to develop implementation strategies to improve risk- aligned surveillance. Implementing risk-aligned surveillance will spare low-risk patients up to 3 unnecessary procedures per year, while concurrently assuring appropriate surveillance among high-risk patients. Our objective is to develop and pilot test a set of implementation strategies for risk-aligned surveillance. Our rationale is that a set of implementation strategies including 3 to 4 targeted strategies will likely reduce both overuse of surveillance among low-risk and underuse of surveillance among high-risk patients. Guided by the Tailored Implementation for Chronic Diseases (TICD) framework, we will pursue the following Specific Aims: (1) To identify provider- and facility-level barriers and facilitators for risk-aligned bladder cancer surveillance; (2) To develop a set of implementation strategies for risk-aligned bladder cancer surveillance; (3) To pilot a set of implementation strategies to improve risk-aligned bladder cancer surveillance. Our study addresses the HSR&D priority area “Implementation Science”. It is the first to focus on improving care among Veterans diagnosed with bladder cancer, the third most prevalent non-cutaneous cancer in VA, and the first to develop a set of implementation strategies for risk-aligned cancer surveillance. We will use a mixed- methods approach to assess provider- and facility-level barriers and facilitators for risk-aligned surveillance in 4 facilities with greatest room for improvement and in 2 facilities where risk-aligned surveillance is common. We will use a 6-step Intervention Mapping process to map barriers to strategies known to effectively target them. We will involve providers and patients during prioritization and specification of strategies and develop a set of 3 to 4 targeted implementation strategies. Finally, we will conduct a pilot study at the 4 facilities with room for improvement, assessing acceptability, appropriateness, feasibility, and potential effectiveness. After completion of this work, we will have developed a highly specified set of implementation strategies. The next step will be a large scale implementation trial, in which we will test the implementation strategies in a cluster-randomized trial in a wider array of facilities. While this study is focused on bladder cancer, risk-aligned surveillance is also relevant for many other cancers. Thus, the implementation strategies identified herein will be the foundation for efficient risk-aligned cancer surveillance for patients with many types of cancer. As such, our research has the potential for broad impact on delivery of risk-aligned cancer surveillance in VA.

患有早期膀胱癌的患者经常接受监视膀胱镜检查程序， 将照相机插入膀胱以检测疾病复发。这使得膀胱镜检查最常见 美国退伍军人事务部（VA）每年进行30，000例手术。 国际上一致认为，对早期膀胱癌的监测应与每个 患者复发和进展的风险。风险一致的监测需要膀胱镜检查，每年低- 高危早期膀胱癌一年三次。 然而，风险对齐的监督很少发生。在我们之前的工作中，我们发现75%的低风险患者 太多的监视。同样，我们发现31%的高危患者没有得到足够的监测。过度使用 在低风险患者中是不希望的，因为不必要的膀胱镜检查程序导致更多的不适， 焦虑和成本。高风险患者的使用不足令人担忧，因为这会使他们面临延误的风险 肌肉浸润性癌症的诊断，这与死亡率增加有关。我们还将VA分类 根据他们的护理模式对设施进行评估，发现风险对齐的监测很少，85个中有70个 对低风险和高风险患者进行类似频率监测的设施。很少有人知道的 患者、提供者和设施因素，促进风险一致的监测。因此，迫切需要 了解风险调整监测的决定因素，并制定实施战略，以改善风险- 同步监视实施风险对齐监测将节省低风险患者多达3个不必要的 每年进行一次手术，同时确保对高风险患者进行适当的监测。 我们的目标是制定和试验一套实施战略，以进行风险调整的监测。我们 理由是，一套实施战略，包括3至4个有针对性的战略，可能会减少 对低风险患者过度使用监测，对高风险患者监测不足。为指导 在慢性病定制实施（TICD）框架下，我们将实现以下具体目标：（1） 确定提供者和机构层面的障碍和促进因素，以进行风险一致的膀胱癌监测;（2） 制定一套风险导向的膀胱癌监测实施策略;（3）试行一套 实施战略，以改善风险对齐膀胱癌监测。 我们的研究涉及HSR&D优先领域“实施科学”。率先着力提高 被诊断患有膀胱癌的退伍军人的护理，膀胱癌是VA第三大流行的非皮肤癌， 第一个为风险一致的癌症监测制定一套实施战略。我们将使用混合- 方法评估提供者和机构一级的障碍和促进因素，以进行4 改进余地最大的设施和2个风险一致的监测很常见的设施。我们 将使用一个6步干预映射过程来映射已知的有效针对他们的策略的障碍。 我们将在制定策略的优先级和规范过程中让提供者和患者参与进来，并制定一套3 四是有针对性的实施战略。最后，我们将在4个设施进行试点研究， 改进，评估可接受性、适当性、可行性和潜在有效性。 这项工作完成后，我们将制定一套非常具体的执行战略。的 下一步将是一个大规模的实施试验，我们将在一个 在更广泛的设施中进行随机分组试验。虽然这项研究的重点是膀胱癌， 监测也与许多其他癌症有关。因此，本文确定的实施战略将 成为对多种癌症患者进行有效的风险调整癌症监测的基础。因此，在本发明的一个方面， 我们的研究有可能对弗吉尼亚州癌症风险监测产生广泛的影响。

项目成果

Accurate Documentation Contributes to Guideline-concordant Surveillance of Nonmuscle Invasive Bladder Cancer: A Multisite Department of Veterans Affairs Study.

准确的记录有助于对非肌肉浸润性膀胱癌进行符合指南的监测：退伍军人事务部的一项多地点研究。

• DOI: 10.1016/j.urology.2023.08.014
• 发表时间: 2023
• 期刊: Urology
• 影响因子: 2.1
• 作者: Lyall,Vikram;OuldIsmail,AAziz;Haggstrom,DavidA;Issa,MutaM;Siddiqui,MMinhaj;Tosoian,Jeffrey;Schroeck,FlorianR
• 通讯作者: Schroeck,FlorianR

Data-driven approach to implementation mapping for the selection of implementation strategies: a case example for risk-aligned bladder cancer surveillance.

• DOI: 10.1186/s13012-022-01231-6
• 发表时间: 2022-09-01
• 期刊: IMPLEMENTATION SCIENCE
• 影响因子: 7.2
• 作者: Schroeck, Florian R.;Ismail, A. Aziz Ould;Haggstrom, David A.;Sanchez, Steven L.;Walker, DeRon R.;Zubkoff, Lisa
• 通讯作者: Zubkoff, Lisa

Partial Versus Complete Bacillus Calmette-Guérin Intravesical Therapy and Bladder Cancer Outcomes in High-risk Non-muscle-invasive Bladder Cancer: Is NIMBUS the Full Story?

• DOI: 10.1016/j.euros.2021.01.009
• 发表时间: 2021-04
• 期刊: European urology open science
• 影响因子: 2.5
• 作者: Rezaee ME;Ismail AAO;Okorie CL;Seigne JD;Lynch KE;Schroeck FR
• 通讯作者: Schroeck FR

Using electronic health records to streamline provider recruitment for implementation science studies.

• DOI: 10.1371/journal.pone.0267915
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7