Increasing Engagement in Patient Reported Outcome Measurement to Address Breast Cancer Care Disparities using Health Information Technology in Community Cancer Settings

项目摘要/摘要 乳腺癌相关结果的主要差异已被广泛记录在整个癌症护理中 与黑人患者相比，黑人患者的死亡率更高，生活质量(QOL)更低 白人病人。尽管有令人信服的证据表明常规的患者报告结果(PRO)测量可以 改善结果和患者在肿瘤学，PRO报告仍然很低的黑人患者和 在社区癌症护理(CCC)环境中，他们经常在那里接受护理。这个项目的总体目标是 拟议的研究是通过建立以下方式提高黑人乳腺癌患者在专业报告中的参与度 在CCCS中服务高比例的灵活且上下文一致的HIT辅助PRO实施模型 黑人病人。完成这项工作将为在临床护理中增加PRO的常规使用奠定基础 改善健康结果，减少黑人患者之间的差距。与美国医学会 社区癌症中心(ACCC)，我们将开发成功实施PRO报告的模式 在ACCC网络中服务于高比例黑人癌症患者的五个CCC中(Boston Medical 中心，波士顿，马萨诸塞州；浸信医院，孟菲斯；布鲁克林卫理公会，纽约布鲁克林；马里兰大学， 马里兰州巴尔的摩；马里兰州拉纳姆的卢米尼斯健康中心)。这项研究的热门平台将得到改善，史诗- 集成PRO平台和以首选项为中心的自动反馈和资源(AFR)， 黑人病人的需要和价值观。根据NCI和NIMHD的优先事项，我们将(目标1)确定 黑人乳腺癌患者HIT辅助PRO数据收集的挑战、障碍和推动因素 在CCCS中接受关怀，并制定解决这些因素的PRO实施模式；(目标2)实施 在五个CCCS中分阶段实施PRO数据收集模型，使用PDSA周期来改进模型 和RE-AIM框架以评估成功；以及(目标3)探索在以下方面发现差距的潜力 基于临床护理中使用的PRO数据的结果，以指导未来的质量改进工作。我们期望的是 结果是对触发或阻止黑人乳腺癌患者的因素的概括性知识 参与度、模型以及培训材料和工具，以实现可行、务实和可持续的 在整个ACCC网络中实施计划。全国超过80%的癌症患者接受了 CCCS的护理，全国约65%的癌症患者由ACCC成员治疗 网络。这项基础性工作的完成，广泛传播了通过 ACCC和其他，将释放PRO报告对历史上未得到充分服务的患者的好处，并推动 公平的癌症护理。这项工作还将支持一项继续研究的方案，以扩大实施 以及在其他不同的肿瘤学患者群体中评估PRO计划，确定增加的 AFR的好处，并进一步使用PRO数据来提高质量。

Project Summary/Abstract Major disparities in breast cancer-related outcomes have been widely documented across the cancer care continuum, with Black patients experiencing higher mortality and decreased quality of life (QOL) compared to White patients. Despite compelling evidence that routine patient-reported outcome (PRO) measurement can improve outcomes and patient experiences in oncology, PRO reporting remains low among Black patients and within the community cancer care (CCC) setting where they often receive care. The overall goal of this proposed study is to increase Black breast cancer patient engagement in PRO reporting by establishing flexible and contextually aligned HIT-assisted PRO implementation models in CCCs serving a high proportion of Black patients. Completing this work will set the stage to increase routine use of PROs in clinical care to improve health outcomes and reduce disparities among Black patients. In partnership with the Association of Community Cancer Centers (ACCC), we will develop models for successful implementation of PRO reporting in five CCCs in the ACCC network that serve a high proportion of Black cancer patients (Boston Medical Center, Boston, MA; Baptist Hospital, Memphis TN; Brooklyn Methodist, Brooklyn NY; University of Maryland, Baltimore, MD; Luminis Health, Lanham, MD). The HIT platform for this study will be imPROVE, an Epic- integrated PRO platform with automated feedback and resources (AFR) centered around the preferences, needs and values of Black patients. In line with the priorities of the NCI and NIMHD, we will (Aim 1) identify challenges, barriers, and enablers to HIT-assisted PRO data collection among Black breast cancer patients receiving care in CCCs and develop PRO implementation models that address these factors; (Aim 2) conduct a phased implementation of the PRO data collection models in five CCCs using PDSA cycles to refine models and the RE-AIM framework to evaluate success; and (Aim 3) explore the potential of detecting disparities in outcomes based on PRO data used in clinical care to inform future quality improvement efforts. Our expected outcomes are generalizable knowledge of the factors that trigger or deter Black breast cancer patient engagement, and models with training materials and tools for feasible, pragmatic, and sustainable PRO program implementation across the ACCC network. More than 80% of cancer patients nationwide receive their care at CCCs, and approximately 65% of the nation’s cancer patients are treated by a member of the ACCC network. The completion of this foundational work, with broad dissemination of lessons learned through the ACCC and beyond, will unlock the benefits of PRO reporting to historically underserved patients and advance equitable cancer care. This work will also support a continued program of research to expand implementation and evaluation of PRO programs among other diverse patient populations in oncology, determine the added benefit of AFR, and further the use of PRO data for quality improvement.