Translating Research Into Practice: A Regional Collaborative to Reduce Disparities in Breast Cancer Care

项目摘要 将科学证据转移并应用于日常实践对于减轻健康是必要的。 差距很大，但在弱势群体中广泛实施循证干预仍然存在障碍 经历不平等的社区。波士顿乳腺癌公平联盟成立于2014年 应对少数民族、低收入妇女乳腺癌死亡率在全市范围内的持续差异。这个 联盟确定了三种已知的减少护理延误的循证策略，但尚未得到证实 部署到临床实践，由于缺乏实施战略(T3-T4实施翻译)。 翻译研究转化为实践(TRIP)借鉴了社区参与传播的原则 和实施科学，以系统地促进部署和利用：(A)区域患者 登记；(B)通过个人化转诊计划系统地筛查社会护理障碍；和(C)病人 将导航服务整合为一个综合护理模式，以提高提供护理的质量和效果， 在这种情况下，针对患有乳腺癌的少数族裔和/或低收入妇女。马萨诸塞州CTSA的四个枢纽 (波士顿大学、哈佛大学、塔夫茨大学和马萨诸塞大学)与 波士顿乳腺癌公平联盟克服广泛实施和传播的障碍 建立以证据为基础的做法，以改善向弱势妇女提供符合指南的护理。 这项研究将分三个阶段进行：第一，我们将部署区域CTSA专业人员支持当地 医疗保健社区开发三个个人旅行组件，创建研究数据存储库，以及 细化干预组件并将其集成到一个可在 合作地点的临床工作流程的背景。然后，我们将进行一种类型1混合有效性- 在6个卫生系统中对1100名易患乳腺癌患者寻求治疗的实施研究 在波士顿。我们将评估医疗保健系统实施这三个通用工具的能力(保真度 将干预方案、成本、当地采用率/可持续性和可接受性)整合为综合干预措施 以及对临床结果的影响(首次治疗的时间和接受符合指南的癌症治疗)。 最后，我们将推动向其他CTSA枢纽、卫生系统和社区广泛传播- 学术伙伴关系。我们的主要假设是，这些工具的广泛应用将消除 护理提供方面的差异，而CTSA中心拥有克服这些障碍的翻译专业知识 实施。

Project Summary The transfer and application of scientific evidence into everyday practice is necessary to mitigate health disparities, yet roadblocks persist in broad implementation of evidence-based interventions among vulnerable communities experiencing disparities. The Boston Breast Cancer Equity Coalition was formed in 2014 in response to persistent city-wide disparities in breast cancer mortality among minority, low-income women. The Coalition identified three evidence-based strategies known to reduce delays in care that have yet to be deployed into clinical practice, due to a lack of implementation strategies (T3-T4 implementation translation). Translating Research into Practice (TRIP) draws upon the principles of community-engaged dissemination and implementation science to systematically facilitate deployment and utilization of: (a) regional patient registries; (b) systematic screening for social barriers to care with a personalized referral plan; and (c) patient navigation services into one integrated model of care to improve the quality and effectiveness of care delivery, in this case for minority and/or low-income women with breast cancer. The four Massachusetts CTSA hubs (Boston University, Harvard University, Tufts University, and University of Massachusetts) partnered with the Boston Breast Cancer Equity Coalition to overcome barriers to widespread implementation and dissemination of evidence based practices that will improve the delivery of guideline-concordant care to vulnerable women. The study will be conducted in three phases: First, we will deploy regional CTSA expertise to support the local healthcare community to develop the three individual TRIP components, create the study data repository, and refine and integrate the intervention components into a cohesive package that can be implemented within the context of the clinical work flow of the partnering sites. Then, we will conduct a type 1 hybrid effectiveness- implementation study among 1,100 vulnerable breast cancer patients seeking care across six health systems in Boston. We will evaluate the healthcare system’s ability to implement these three generalizable tools (fidelity to intervention protocol, costs, local adoption/sustainability, and acceptability) into an integrated intervention and the impact on clinical outcomes (time to first treatment and receipt of guideline concordant cancer care). Finally, we will promote widespread dissemination to other CTSA hubs, health systems, and community- academic partnerships. Our main hypothesis is that widespread implementation of these tools will eliminate care delivery disparities, and CTSA hubs have the translational expertise to overcome barriers to such implementation.