Promoting Early Utilization of Palliative Care for African Americans Using Culturally Informed Patient Navigation

项目摘要 尽管大多数美国人希望在家中安详地死去，但也有许多人在痛苦中死去，死在医院里。四分之一 超过1000亿美元的医疗保险资金用于患者的最后一年，其中许多人是癌症患者。在……里面 简而言之，迫切需要更高质量、更负担得起、更好地以患者为中心的重症护理 和垂死的病人。对临终病人和重病患者的有效姑息护理满足了这一需求。另外， 美国医疗保健质量的提高并没有同样惠及低收入和少数族裔患者， 谁仍然更有可能在临床范围内有更差的医疗保健经历和结果 环境和疾病。患者导航器计划，其中非专业卫生工作者帮助患者导航 系统已经显示出改善特定患者群体的护理质量的希望，但没有 由于费用和特定疾病的内容而被广泛实施。成本更低、适用范围更广的计划 将有可能为更多的人口提高质量和成果。的长期目标是 K08候选人法比安·约翰斯顿，医学博士，MHS，旨在改善医疗保健质量、经验和结果 通过开发和评估面向系统、家庭参与的干预措施 可能会对人口产生广泛影响。这一目标与AHRQ、NCI和PCORI的优先领域一致 改进护理模式的实施，利用利益攸关方参与，减少差距和 改善姑息治疗的使用。 为了实现他的目标，约翰斯顿博士将进行授课和体验式培训，以提高知识 和四个领域的技能：(1)患者导航；(2)参与者参与的项目开发和研究；(3) 比较有效性和利益攸关方参与；以及(4)传播和实施科学。 约翰斯顿博士组建了一个拥有医疗保健质量研究专业知识的指导团队， 差异、患者导航、姑息治疗、利益相关者参与和参与者参与研究，以 确保完成拟议的研究和培训，并成功过渡到独立。Dr。 约翰斯顿提出了三个连续的、创新的项目，以他的培训目标为基础。这些项目将 帮助制定和试点评估为非洲量身定做的文化导航方案 美国晚期实体器官恶性肿瘤患者，有针对性地提前制定护理计划，疼痛 管理和临终关怀转诊。具体目标是：(1)与关键利益攸关方合作，制定 有针对性的患者导航计划；(2)试点测试文化定制的患者导航干预；以及(3) 评估先锋评估的患者导航的可行性、可接受性、成本和影响 在非洲裔美国晚期恶性肿瘤患者中进行的随机试验。 这项建议很新颖，因为它 患者导航在需要姑息治疗的患者中的应用；及其在利益相关者参与中的应用 帮助将导航调整为更简短、成本更低的干预措施，以便于传播。

Project Summary Although most Americans wish to die peacefully at home, many die in pain and in the hospital. A quarter of Medicare dollars – over $100 billion - is spent for patients in their last year of life many are cancer patients. In brief, there is a desperate need for higher quality, more affordable, better patient-centered care for severely ill and dying patients. Effective palliative care for dying and severely ill patients meets this need. Additionally, improvements in the quality of US health care have not equally benefitted low income and minority patients, who remain more likely to have worse health care experiences and outcomes across the spectrum of clinical settings and diseases. Patient navigator programs, in which lay health workers help patients navigate the system, have shown promise for improving quality of care among specific patient populations, but are not widely implemented due to cost and disease-specific content. A less costly, more broadly applicable program would have the potential to improve quality and outcomes for a larger population. The long-term objective of the K08 candidate, Fabian Johnston, MD, MHS, is to improve health care quality, experiences and outcomes for underserved patients by developing and evaluating systems-oriented, family- engaged interventions with potential for broad population impact. This goal is consistent withAHRQ, NCI, and PCORI, priority areas of improving implementation of models of care, utilization of stakeholder engagement, reduction of disparities and improved use of palliative care. To achieve his objective, Dr. Johnston will undertake didactic and experiential training to improve knowledge and skills in four areas: (1) patient navigation; (2) participant-engaged program development and research; (3) comparative effectiveness and stakeholder engagement; and (4) dissemination and implementation science. Dr. Johnston has assembled a mentorship team with expertise in health care quality research, disparities, patient navigation, palliative care, stakeholder engagement and participant-engaged research, to ensure completion of the proposed research and training and successful transition to independence. Dr. Johnston proposes three sequential, innovative projects that build upon his training goals. These projects will contribute to the development and pilot evaluation of a culturally tailored navigation program for African American patients with advanced solid organ malignancies, targeted to the advance care planning, pain management, and hospice referral. The specific aims are: (1) to collaborate with key stakeholders to develop a targeted patient navigation program; (2) to pilot test the culturally tailored patient navigator intervention; and (3) toassess the feasibility, acceptability, cost, and impact of patient navigation as assessed by a vanguard randomized trial among African American patients with advanced malignancies. This proposal is novel in its application of patient navigation to patients in need of palliative care; and in its use of stakeholder engagement to aid in adaptation of navigation into a briefer, less costly intervention to facilitate dissemination.