Research Project 2

研究项目2

• 批准号: 10738713
• 负责人: karla unger
• 金额: $ 17.34万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-20 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738713
• 关键词: Address; Area; Breast; Breast Cancer Patient; Breast Cancer Treatment; Cancer Center; Cancer Control; Capital; Caring; Case Manager; Cities; Clinic; Clinical; Collaborations; Consultations; Country; Diagnosis; Diagnostic; Diagnostic Services; Face; Focus Groups; Funding; Goals; Government; Health Care Costs; Health Personnel; Health system; Healthcare; Healthcare Systems; Home; Human Resources; Hybrids; Image; Implementation readiness; Income; Institution; Intervention; Interview; Language; Latin American; Malignant Neoplasms; Mammographic screening; Maps; Measures; Medical; Mentors; Mexican; Mexico; Outcome; Pathology; Patient-Focused Outcomes; Patients; Population; Primary Care; Protocols documentation; Public Health; Quality of life; Randomized; Rapid diagnostics; Recommendation; Research Project Grants; Resources; Structure; Symptoms; System; Systems Integration; Testing; Time; Uninsured; Woman; World Health Organization; advanced disease; breast cancer diagnosis; cancer care; cancer diagnosis; care delivery; cost; design; diagnostic platform; effectiveness evaluation; effectiveness outcome; effectiveness/implementation study; experience; follow-up; implementation barriers; implementation design; implementation facilitators; implementation fidelity; implementation outcomes; implementation science; implementation strategy; improved; innovation; integrated care; low and middle-income countries; malignant breast neoplasm; metropolitan; mortality; organizational readiness; primary care clinic; primary care setting; programs; rapid diagnosis; screening; treatment services; uptake

Implementation of integrated care for rapid breast cancer diagnosis ABSTRACT Consistent with the second pillar of WHO's Global Breast Cancer Initiative for improving breast cancer (BC) control in LMICs, our long-term goal is to improve the timeliness of breast cancer diagnosis in Mexico. The goal of the proposed study is to develop and test implementation strategies designed to improve integrated care for rapid BC diagnosis across health system levels among women presenting with BC in primary care settings. The Specific Aims are: (1) Assess barriers, facilitators, and organizational readiness for implementation of rapid BC diagnosis system. We will conduct qualitative interviews with healthcare personnel (informed by CFIR and ISF frameworks) to identify barriers and facilitators for implementation. Also, we will cross culturally adapt the R=MC 2 measure and assess organizational readiness across the 166 primary care centers that serve the uninsured population in Monterrey, Nuevo León. (2) Develop strategies to improve the implementation of a rapid BC diagnosis system. Using Implementation Mapping in collaboration with the key stakeholders, we will design contextually appropriate implementation strategies (including practice facilitation) to address barriers and strengthen organizational readiness for implementation of integrated care that will enable rapid diagnosis. (3) Evaluate the impact of practice facilitation on implementation of a rapid BC diagnosis system and determine effectiveness on patient outcomes. We will conduct a hybrid type 2 implementation-effectiveness study using a cluster randomized stepped-wedge design. Primary implementation outcome: reduction in the time between symptomatic presentation at the primary care clinics and arrival to the diagnostic clinic. Effectiveness outcome: down-shift in the stage of BC. The proposed study will address a pressing need in BC control in Mexico (and other LMICs), and advance implementation science by adapting and validating a Spanish language organizational readiness measure and evaluating the use of practice facilitation to improve readiness for implementation of cancer control practice change in LMICs.

实施一体化护理以快速诊断乳腺癌 摘要 符合世卫组织全球乳腺癌倡议的第二个支柱， 乳腺癌（BC）控制在中低收入国家，我们的长期目标是提高及时性， 乳腺癌诊断在墨西哥拟议研究的目标是开发和测试 旨在改善快速BC综合护理的实施战略 在初级教育中出现BC的妇女中， 护理设置。具体目标是： (1)评估实施的障碍、促进因素和组织准备情况， 快速BC诊断系统。我们将对医疗保健进行定性访谈， 人员（根据CFIR和ISF框架提供信息），以确定障碍和促进因素 供执行。此外，我们将跨文化适应R=MC 2措施和评估 在166个为未投保者服务的初级保健中心做好组织准备 人口在蒙特雷，努埃沃。(2)制定战略， 实现快速BC诊断系统。使用实现映射 通过与主要利益相关者的合作，我们将设计出适合环境的 解决障碍和问题的实施策略（包括实践促进） 加强实施综合护理的组织准备， 快速诊断。(3)评估实践促进对以下方面的影响 快速BC诊断系统实施及对患者的有效性测定 成果。我们将进行一项混合型2实施效果研究， 整群随机阶梯楔形设计。主要执行成果：减少 在初级保健诊所出现症状和到达 诊断诊所。有效性结果：BC阶段下移。拟议 一项研究将解决墨西哥（和其他中低收入国家）在BC控制方面的迫切需要， 通过调整和验证西班牙语来推进实施科学 组织准备程度的衡量和评价实践促进的使用， 提高中低收入国家实施癌症控制实践变革的准备程度。