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

描述（由申请人提供）：与白人相比，非裔美国癌症患者继续开始治疗的时间较晚，并且不易接受完整治疗；导致更糟糕的治疗结果，包括更短的生存期。几十年来，反种族主义组织一直将“透明度”和“问责制”的概念作为制度变革的机制应用于民权和社会变革。然而，很少将这些概念应用于卫生系统的变化和不平等待遇。目标：格林斯博罗健康差异协作组织和两家癌症中心联合起来，指定癌症护理系统内的结构，使癌症护理容易受到制度性种族主义的影响，并研究如何改变这些结构，以减少1-2期乳腺癌和肺癌患者治疗质量和完成度方面的种族不平等。通过消除种族主义和公平（ACCURE）系统改变干预的问责制是由CBPR原则、消除种族主义mtm框架和我们的初步研究结果提供的。方法：ACCURE有2个透明度组成部分和2个问责制组成部分，假设是为了减少早期乳腺癌和肺癌完成治疗中的种族不平等：1)分析患者在治疗过程中对“压力点遭遇”的反馈，这些反馈会影响癌症治疗的质量和完成；2)医疗公平培训+针对机构种族主义与癌症治疗相关性的提供者的促进会议；3)医师冠军每月向临床医生及其团队提交临床表现报告，内容包括针对患者的种族、护理质量数据+改善护理的建议；4)经过专门培训的ACCURE Navigator，为患者的听力和反应提供双向沟通桥梁。为了实时评估治疗完成后干预的单独和联合效应，我们提出了一个5年中断时间序列，嵌入3年随机对照试验，研究设计。研究结果的潜在影响是：帮助确定国家决策机构制定的卫生信息技术的“有意义使用”要求；为美国外科医师学会快速质量报告系统做出贡献；最终，在医疗体系内创造可持续的变化。我们的系统方法有潜力优化透明度和种族平等问责制，在1500个癌症中心完成治疗，每年影响140万癌症患者。

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.