KanSurvive: Testing a model for improving cancer survivorship care in rural practice

摘要 急性期和长期护理阶段的癌症幸存者将受益于质量和 协调他们接受的初级和癌症护理。癌症研究人员已经离开了农村的管理 癌症幸存者在很大程度上没有得到研究。虽然有循证实践指南，但在农村地区实施 初级保健实践已达不到要求。研究尚未完全确定阻碍成功的障碍 在这些环境中执行指导方针。有机会提高对双方的理解 为什么癌症生存护理在农村初级保健中是次优的原因以及测试机制 帮助实践实施系统，确保所有癌症幸存者都可以被识别并接受 指导方针协调性护理。这项研究旨在评估目前农村癌症幸存者的管理做法。 并测试KanSurvive项目回声干预，以改变交付基于证据的实践 生还者护理。主要目标是1)描述保健、基础设施需求和流程方面的差距 农村初级保健诊所对急性和慢性癌症存活者的关怀，重点放在农村乳房，结直肠， 在完成KanSurvive项目ECHO干预时，肺癌、前列腺癌幸存者；2)评估 实践促进与远程指导计划相结合的有效性，以加强证据的采用- 基于乳腺癌、结直肠、肺和前列腺癌幸存者的实践指南；以及3)描述关键促进剂 KanSurvive项目实施的障碍、回声和相关EHR文件的证据 这些做法的改变。这一新颖的项目将为实施科学的使用和 建立“实践社区”，共同努力改善农村癌症患者的生存护理。 诊断到生命的尽头。

ABSTRACT Cancer survivors in the acute and extended phases of care would benefit from improvements in the quality and coordination of primary and cancer care they receive. Cancer researchers have left the management of rural cancer survivors largely unstudied. While evidence-based practice guidelines exist, implementation in rural primary care practices has fallen short. Studies have yet to fully identify the barriers preventing successful implementation of guidelines in these settings. Opportunities exist to improve the understanding of both the reasons why cancer survivorship care is sub optimal in rural primary care as well as to test mechanisms for helping practices implement systems that assure all cancer survivors can be identified and are receiving guideline concordant care. This study sets out to evaluate current practices in managing rural cancer survivors and test a KanSurvive Project ECHO intervention to transform practices for delivery of evidence-based survivorship care. The primary aims are to 1) describe gaps in care, infrastructure needs and processes of care for acute and chronic cancer survivorship in rural primary care clinics focusing on rural breast, colorectal, lung, and prostate cancer survivors while finalizing the KanSurvive Project ECHO intervention; 2) evaluate the effectiveness of practice facilitation integrated with telementoring program for enhancing adoption of evidence- based practice guidelines for breast, colorectal, lung, and prostate survivors; and 3) describe key facilitators and barriers to implementation of KanSurvive Project ECHO and evidence of related EHR documentation change in these practices. This novel project will provide a model for use of implementation science and the development of a “community of practices” working together to improve rural cancer survivorship care from diagnosis to the end-of-life.