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

描述(申请人提供)：与白人癌症患者相比，非裔美国人癌症患者继续开始治疗的时间较晚，接受完全治疗的可能性较小；这加剧了更糟糕的治疗结果，包括较短的生存期。作为制度变革机制的“透明度”和“问责制”的概念，几十年来一直被反种族主义组织应用于公民权利和社会变革。然而，将这些概念应用于卫生系统的变革和不平等待遇的工作很少。目的：格林斯博罗健康差异合作组织和两个癌症中心联合起来，明确癌症护理系统中的结构，使癌症护理容易受到制度性种族主义的影响，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治疗质量和完成治疗方面的种族不平等。通过撤销种族主义和公平(ACCURE)系统变化干预对癌症护理的问责受到CBPR原则、撤销racismTM框架和我们初步研究的结果的启发。方法：ACCURE有两个透明度部分和两个责任部分，假设减少在完成早期乳腺癌和肺癌治疗过程中的种族不平等：1)权力和权力分析，患者在治疗期间就破坏癌症护理质量和完成的“压力点遇到”表达他们的反馈；2)医疗公平培训+为提供者提供关于机构种族主义与癌症护理相关性的助推会；3)由医生冠军向临床医生及其团队提供关于种族特定的临床表现报告，他们的患者的护理质量数据+改善护理的建议；和4)经过专门培训的ACCURE导航器，为患者的听力和反应提供双向沟通桥梁。为了实时评估干预后完成治疗的单独和综合影响，我们提出了一个5年中断时间序列，并嵌入了一个为期3年的随机对照试验，研究设计。这些发现的潜在影响是：帮助定义由国家决策机构建立的医疗信息技术的“有意义的使用”要求；为美国外科医师学会快速质量报告系统做出贡献；并最终在保健系统内创造可持续的变化。我们的系统方法有可能在完成1500个癌症中心的治疗过程中优化种族公平的透明度和问责制，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.