Improving rural cancer care delivery

项目摘要/摘要 尽管癌症治疗的进步总体上提高了患者的存活率，但农村地区的癌症死亡率 人口仍然不成比例地高于城市人口。癌症死亡率的城乡差异 这一比率被认为在一定程度上反映了农村地区的次优护理协调。居住在农村的癌症患者 地区面临更大的护理协调挑战，包括获得医疗保健、旅行的机会有限或缺乏 负担、专家短缺以及在接受诊断和诊断后干预方面的延误。延误时间 诊断和治疗的启动已被证明会对患者的存活率产生不利影响；这种延迟已被证实 与癌症死亡风险的三倍有关。然而，人们对农村癌症患者的看法知之甚少。 在具体的癌症护理协调过程中的城乡差异，以及 农村癌症护理协调提供具体的护理成果。拟议的研究将解决这些问题 知识差距和实现以下目标：目标1)比较农村和城市癌症患者 护理协调的感知和目的2)检查农村癌症患者之间的联系 对护理协调和具体护理交付结果的感知(从第一个症状到诊断的时间、时间 从诊断到治疗开始)。这些目标将为具体的护理协调进程提供信息 对农村癌症患者的影响不成比例，以及改善农村癌症护理服务的方法。调查结果将 指导以改善农村癌症护理提供为重点的未来干预措施的发展，并可能作出贡献 为了提高癌症护理的质量和价值，减轻农村癌症患者的护理负担， 并解决农村癌症健康差距问题。这项拟议的研究推动了医疗保健机构的发展 研究与质量(AHRQ)S重点研究和评估重点人群的保健服务 居住在农村地区。建议的奖学金旨在增强申请者在以下方面的知识和技能 在专家指导和指导委员会的指导下进行卫生服务研究，并包括更大的培训 为申请人职业生涯的下一步成为独立人士做好准备的计划 调查员。培训和研究将在70个指定的国家癌症研究所之一进行 癌症中心。在完成拟议的研究和培训后，申请者将理想地准备好 提交一份完整的K01申请，重点是开发和测试旨在改善癌症的干预措施 农村地区的关爱协调。她目前和未来的研究目标将通过专注于 关于向居住在农村地区的高度优先人口提供保健服务的问题。

Project Summary/Abstract Although advances in cancer treatment have improved patient survival overall, cancer mortality rates in rural populations remain disproportionately higher than urban populations. Rural-urban disparities in cancer mortality rates are thought to, in part, reflect suboptimal care coordination in rural areas. Cancer patients residing in rural areas experience greater care coordination challenges including limited or lack of access to medical care, travel burdens, shortages of specialists, and delays in receiving diagnosis and post-diagnosis intervention. Delays in diagnosis and treatment initiation have been shown to adversely impact patient survival; such delays have been associated with a three-fold cancer mortality risk. However, little is known about rural cancer patients’ perception of care coordination, rural-urban differences in specific cancer care coordination processes, and the impact of rural cancer care coordination on specific care delivery outcomes. The proposed research will address these knowledge gaps and accomplish the following aims: Aim 1) To compare rural and urban cancer patients’ perception of care coordination and Aim 2) To examine the associations between rural cancer patients’ perception of care coordination and specific care delivery outcomes (time from first symptoms to diagnosis, time from diagnosis to treatment initiation). These aims will inform specific care coordination processes that disproportionately impact rural cancer patients and ways to improve rural cancer care delivery. Findings will guide the development of future interventions focused on improving rural cancer care delivery and may contribute to improved quality and value of cancer care, reduce burdens related to care delivery for rural cancer patients, and address rural cancer health disparities. The proposed research advances the Agency for Healthcare Research and Quality (AHRQ)’s focus on research and evaluation of health care delivery in a priority population residing in rural areas. The proposed fellowship is designed to enhance the applicant’s knowledge and skills in health services research under expert mentorship and a mentoring committee, and includes a larger training plan developed to prepare the applicant for the next step in her career toward becoming an independent investigator. Training and research will be conducted at one of the 70 National Cancer Institute-designated cancer centers. Upon completion of the proposed research and training, the applicant will be ideally poised to submit a complete K01 application focused on developing and testing an intervention aimed to improve cancer care coordination in rural areas. Her current and future research aims will advance AHRQ’s mission by focusing on the delivery of health care in a high priority population residing in rural areas.