Understanding Pathways to Earlier Diagnosis for Ovarian Cancer in North Carolina

摘要 北卡罗来纳州和美国东南部农村的居民患慢性病的比例最高， 受健康的社会决定因素的重大影响， （SDH）。这个应用程序的目标是：（1）与我们的社区合作伙伴，建立和维护一个强大的中心 支持应用预防研究、翻译研究成果和传播证据的基础设施- 的产品，和（2）确定的过程，我们证明的生活方式干预（地中海南部 生活方式计划- MSLP）可以有效地转化为公共卫生和临床实践的支持， 以社区为基础的资源，以消除粮食不安全。MSLP基于地中海饮食， 根据南方低资源人口的口味偏好和食物供应量定制， 高血压、糖尿病和肥胖症的积极健康结果。虽然科学原理 实施生活方式干预措施是稳健的，支持大规模实施的证据有限 这些干预措施在临床和公共卫生环境中的应用。我们提出了一个实施核心研究 项目分为3个阶段，遵循多种实施理论和知识转化为行动框架。 我们的研究旨在确定MSLP最有效的过程， 有效地转化为公共卫生（地方卫生部门）和临床（社区卫生中心） 在少数民族、农村和医疗服务不足人群中积极影响慢性病风险降低的做法 人口。在第一阶段，我们将确定实施的促进因素和障碍，并开发、试点测试和 完善将用于大规模实施MSLP的实施战略。在第二阶段，我们将采用 一种有效性-实现混合设计，用于比较两种格式，以便在实现时按比例放大MSLP 结果（主要目的），并确认MSLP对行为和临床结果的影响（次要目的）。在 第三阶段，我们将在北卡罗来纳州启动MSLP的全面实施，并与NC目前的 过渡到医疗补助管理式护理，州卫生部门（HD）的政策将“指导计划， 提供者朝着实施以全人为中心的，协调良好的护理系统， 解决了医疗和非医疗健康驱动因素。”我们正在讨论将MSLP集成到 几家健康保险公司的保险计划申请作为新的预付健康计划， 医疗补助管理的护理系统。我们将使用我们国家认可的培训和研究中心 进行翻译，以便沿着传播卫生政策制定方案制作的其他循证干预措施的MSLP材料 和PRC网络，突出那些支持新的疾病预防控制中心资助的方案。最后我们将 继续与州卫生署合作，为一个强大的全州资源平台提供信息-一个数据库和电话 中心连接公共卫生和临床医生的资源，在他们的社区解决社会 健康的决定因素，如粮食不安全。该平台将跟踪各种联系并监测成果。

ABSTRACT Residents of North Carolina and the rural southeastern US experience some of the highest chronic disease rates and greatest health disparities in the country, influenced significantly by social determinants of health (SDH). The goals of this application are to: (1) with our community partners, build and maintain a strong Center infrastructure to support applied prevention research, translate research findings, and disseminate evidence- based products, and (2) determine the processes by which our proven lifestyle intervention (Med-South Lifestyle Program - MSLP) can be efficiently translated into public health and clinical practice supported by community-based resources to combat food insecurity. The MSLP, based on the Mediterranean diet but tailored to the taste preferences and food availability of a southern low-resource population, has resulted in positive health outcomes for hypertension, diabetes, and obesity. Although the scientific rationale for implementing lifestyle interventions is robust, evidence is limited on supporting the broad-scale implementation of these interventions in clinical and public health settings. We propose an Implementation Core Research Project with 3 phases informed by multiple implementation theories and the Knowledge into Action Framework. Our research is designed to determine the processes by which the MSLP can be most efficiently and effectively translated into public health (local health departments) and clinical (community health centers) practice to positively impact chronic disease risk reduction among minority, rural, and medically underserved populations. In Phase 1, we will identify facilitators and barriers to implementation and develop, pilot test, and refine implementation strategies that will be used to take the MSLP to scale. In Phase 2, we will apply an effectiveness-implementation hybrid design to compare two formats for scaling up MSLP on implementation outcomes (primary aim) and confirm MSLP impact on behavioral and clinical outcomes (secondary aim). In Phase 3, we will initiate MSLP's full-scale implementation in North Carolina in coordination with NC's current transition to Medicaid Managed Care where state health department (HD) policies will “guide plans and providers toward implementation of a whole-person centered, well-coordinated system of care, which addresses both medical and non-medical drivers of health.” We are discussing integrating the MSLP in the coverage plans of several health insurance companies applying to serve as Pre-paid Health Plans in the new Medicaid Managed care system. We will use our nationally recognized Center for Training and Research Translation to disseminate MSLP materials along with other evidence-based interventions produced by HPDP and the PRC Network, highlighting those supporting the new CDC-funded programming. Finally, we will continue working with the State HD to inform a robust Statewide Resource Platform - a database and call center linking public health and clinical practitioners to resources in their communities addressing social determinants of health like food insecurity. The Platform will track connections and monitor outcomes.