Administrative Supplements for the Implementation Science Centers in Cancer Control (ISC3): Advancing Health Equity through Implementation Science

项目摘要 健康的社会决定因素(SDOH)、社会风险因素和未得到满足的社会需求对 塑造和加剧癌症发病率、发病率和死亡率方面的健康和健康不平等。有一个 迫切需要准确和全面的方法来了解SDOH如何影响 落实循证癌症护理、公平癌症结局和健康公平。可靠， 为所有患者广泛、有效地测量个体水平的SDOH是关键的第一步 确定那些有更大风险经历不平等和社会需求未得到满足的患者。在我们的 通过实施科学促进卫生公平的ISC3第一阶段行政补编，觉醒 森林iDAPT ISC3和宾夕法尼亚ISC3合作评估最近部署的电子健康记录 (EHR)模块称为Epic®SDOH车轮(这里称为“车轮”)。轮子包括16种物品(例如，食物 不安全、交通需求、住房、财政压力)，以应对社会风险因素和未得到满足的社会 需要。第一阶段是实施前研究，以记录SDOH筛查的当前比率并找出差距 在实施过程中，为扩大SDOH筛查的公平覆盖面提供信息。我们发现很低的比率 肿瘤护理团队采用SDOH筛查的可能性很大，肿瘤患者的覆盖面有限。尽管如此， 我们的关键线人访谈显示，我们承诺通过肿瘤科护理来衡量和解决SDOH 团队和临床领导，以及肿瘤护理团队使用的特定于上下文的SDOH筛查工具 而不是轮子。第一阶段的调查结果为我们提议的第二阶段实施试点研究提供了依据，以增加 在我们中心接受癌症治疗的患者进行SDOH筛查。具体地说，在目标1中，我们将开发 量身定制的实施战略，以增加覆盖范围、公平性和采用SDOH筛查的患者 通过严格的快速评估癌症护理环境和人群中的癌症 肿瘤护理小组在拟议诊所的设置)；调整现有的SDOH筛查工具；以及 确定实施战略，以增加及时和广泛的评估和记录 癌症患者的SDOH筛查。在目标2中，我们将评估有针对性的实施战略的影响 使用电子健康记录数据对癌症患者进行SDOH筛查的可及性、公平性和采用率。 我们将使用半结构化访谈来了解影响覆盖范围、公平性和采用SDOH的因素 从患者、提供者和工作人员的角度进行筛查。我们将利用拟议研究的结果来 开发随机对照试验的R01应用程序，以测试CD2对SDOH筛查范围的影响， 公平、采用和随后的努力，以解决长期或紧急的社会需求 优化患者结局和改善癌症健康公平的目标。

Project Summary Social determinants of health (SDOH), social risk factors, and unmet social needs have critical implications for shaping and exacerbating health and health inequities for cancer incidence, morbidity and mortality. There is a critical need for accurate and comprehensive approaches to understanding how SDOH impact the implementation of evidence-based cancer care, equitable cancer outcomes, and health equity. Reliable, widespread, and available measurement of individual-level SDOH for all patients is a critical first step in identifying those patients at greater risk for experiencing inequities and that have unmet social needs. In our Phase I ISC3 Administrative Supplement for Advancing Health Equity through Implementation Science, Wake Forest iDAPT ISC3 and Penn ISC3 collaborated to evaluate the recent deployment of an electronic health record (EHR) module called the Epic® SDOH Wheel (herein “the Wheel”). The Wheel includes 16 items (e.g., food insecurity, transportation needs, housing, financial strain) that address social risk factors and unmet social needs. Phase I was a pre-implementation study to document current rates of SDOH screening and identify gaps in delivery, to inform strategies for increasing equitable reach of SDOH screening. We found markedly low rates of adoption of SDOH screening by oncology care teams and limited reach to oncology patients. Nonetheless, our key informant interviews revealed a commitment to measuring and addressing SDOH by the oncology care teams and clinical leaders, as well as context-specific SDOH screening tools that oncology care teams used instead of the Wheel. Findings from Phase 1 inform our proposed Phase 2 implementation pilot study to increase SDOH screening in patients undergoing cancer treatment at our Centers. Specifically, in Aim 1, we will develop tailored implementation strategies for increasing reach, equity, and adoption of SDOH screening in patients with cancer across a diverse range of cancer care settings and populations through rigorous rapid assessment of oncology care teams’ setting in the proposed clinics); adaptation of existing SDOH screening tools, and identification of implementation strategies to increase timely and widespread assessment and documentation of SDOH screening in patients with cancer. In Aim 2, we will assess the impact of tailored implementation strategies on reach, equity, and adoption of SDOH screening in patients with cancer using electronic health record data. We will use semi-structured interviews to understand factors influencing reach, equity, and adoption of SDOH screening from the perspective of patients, providers and staff. We will use findings from the proposed study to develop an R01 application for a randomized controlled trial to test the effect of CD2 on SDOH screening reach, equity, and adoption and subsequent efforts to address persistent or emergent social needs with the overarching goal of optimizing patient outcomes and improving cancer health equity.