Accountability for Cancer Care through Undoing Racism and Equity (ACCURE)

描述（由申请人提供）：与白色患者相比，非洲裔美国人癌症患者继续晚些开始治疗，并且仍然不太容易接受完整治疗;导致治疗结果更差，包括生存期更短。几十年来，反种族主义组织一直将"透明度"和"问责制"概念作为制度变革的机制，应用于公民权利和社会变革。然而，很少有人将这些概念应用于卫生系统的变革和不平等待遇。目的：格林斯伯勒健康差异协作组织和两个癌症中心联合起来，指定癌症护理系统中内置的结构，使癌症护理容易受到机构种族主义的影响，并调查如何改变这些结构，以减少1 - 2期乳腺癌和肺癌患者在质量和完成治疗方面的种族不平等。通过消除种族主义和公平（ACCURE）系统改变干预癌症护理的责任是由CBPR原则，消除种族主义TM框架和我们初步研究的结果所告知的。研究方法：ACCURE有2个透明度组成部分和2个问责制组成部分，假设在完成早期乳腺癌和肺癌治疗过程中减少种族不平等：1）权力和权威分析，让患者在治疗过程中就“压力点遭遇”表达他们的反馈，这些压力点会破坏癌症护理的质量和完成; 2）医疗保健公平培训+针对提供者的关于机构种族主义与癌症护理相关性的助推器会议; 3）由医生冠军向临床医生及其团队提供的关于种族特定的月度临床表现报告，患者的护理数据质量+改善护理的建议;以及4）经过专门培训的ACCURE导航器，为患者提供双向沟通桥梁，以听取和回应患者。为了在真实的时间内评估单独和联合效应，从完成治疗的干预开始，我们提出了一个5年的中断时间序列，以及一个嵌入式的3年随机对照试验，研究设计。调查结果的潜在影响是：帮助定义“有意义的使用”的要求，由国家决策机构建立的卫生信息技术;有助于美国外科医生学会快速质量报告系统;并最终在护理系统内创造可持续的变化。我们的系统方法有可能优化种族平等的透明度和问责制，在1500个癌症中心完成治疗，每年影响140万癌症患者。 公共卫生相关性：非洲裔美国癌症患者在治疗过程中经历的持续不平等需要勤奋和大胆的反应。然而，很少有前瞻性研究确定了非裔美国人癌症护理不佳的系统性原因，更少的研究显示了有效的干预措施。ACCURE建议通过为期4年的干预来实现这两个目标，以优化在完成早期乳腺癌和肺癌治疗过程中种族平等的透明度和系统问责制。

DESCRIPTION (provided by applicant): African American cancer patients, as compared to White counterparts, continue to initiate treatment later and remain less apt to undergo complete treatment; fueling worse treatment outcomes including shorter survival. The concepts of "transparency" and "accountability," as mechanisms of systems change have been applied for decades by anti-racism organizations to civil rights and social change. Yet, the application of these concepts to health systems' change and unequal treatment has rarely been done. Objective: The Greensboro Health Disparities Collaborative and two Cancer Centers have joined together to specify structures built into cancer care systems that make cancer care vulnerable to institutional racism and investigate how they can be changed to reduce racial inequity in quality and completion of treatment for Stage 1-2 breast and lung cancer patients. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) systems change intervention is informed by CBPR principles, the Undoing RacismTM framework, and findings from our preliminary studies. Methods: ACCURE has 2 transparency components and 2 accountability components, hypothesized to reduce racial inequities in completing treatment of early stage breast and lung cancer : 1) Analysis of Power and Authority for patients to voice their feedback on "pressure points encounters" during treatment that undermine quality and completion of cancer care; 2) Healthcare Equity Training + booster sessions for providers on the relevance of institutional racism to cancer care; 3) Monthly Clinical Performance Reports delivered by a Physician Champion to clinicians and their teams on race-specific, quality of care data for their patients + suggestions for improving care; and 4) a specially trained ACCURE Navigator to provide a 2-way communication bridge for hearing and responding to patients. To assess the separate and combined effects, in real time, from the intervention on completion of treatment, we propose a 5-year interrupted time series, with an embedded, 3-year randomized control trial, study design. Potential Impact of findings are to: help define "meaningful use" requirements for health IT, established by national policy-making bodies; contribute to the American College of Surgeons Rapid Quality Reporting System; and, ultimately, create sustainable change within systems of care. Our systems approach has the potential to optimize transparency of and accountability for racial equity in completing treatment in 1500 cancer centers affecting 1.4 million cancer patients annually. PUBLIC HEALTH RELEVANCE: Persistent inequities experienced by African American cancer patients while in treatment demand a diligent and bold response. Yet, few prospective studies have identified systemic causes for less than optimal cancer care for African Americans and even fewer show effective interventions. ACCURE proposes to accomplish both of these goals through a 4-year intervention to optimize transparency and system accountability for racial equity in the completion of treatment for early stage breast and lung cancer.