Research Project 2

研究项目2

• 批准号: 10207424
• 负责人: Simona Kwon
• 金额: $ 32.31万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10207424
• 关键词: Abdomen; Accounting; Address; Adherence; Adoption; Antibiotic Therapy; Asian Americans; Asians; Bacteria; Cancer Burden; Cancer Etiology; Cancer Intervention; Carcinogens; Cardiovascular Diseases; Caring; Cause of Death; China; Chinese American; Clinic; Clinical Decision Support Systems; Communities; Community Health Aides; Data; Disease; Dyspepsia; Early Diagnosis; Effectiveness; Electronic Health Record; Endoscopy; Enrollment; Ethnic group; Evaluation; Funding; Goals; Health; Health system; Healthcare Systems; Helicobacter Infections; Helicobacter pylori; Hospitals; Human; Immigrant; Incidence; Infection; Intervention; Lead; Limited English Proficiency; Linguistics; Link; Low income; Malignant Neoplasms; Methods; Modeling; New York City; Not Hispanic or Latino; Observational Study; Patient Education; Patients; Population; Prevention; Prevention Guidelines; Prevention program; Primary Health Care; Provider; Public Health; Randomized Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reproducibility; Research Project Grants; Risk; Risk Factors; Survival Rate; Testing; Treatment Effectiveness; United States; Woman; acceptability and feasibility; arm; associated symptom; base; cancer health disparity; cancer prevention; chronic pain; experience; feasibility testing; follow-up; gastric cancer prevention; health information technology; health literacy; high risk; implementation process; improved; infection rate; malignant stomach neoplasm; medication compliance; men; mortality; patient oriented; programs; racial and ethnic; safety net; screening; theories; therapy design; tool; treatment adherence; treatment as usual; trial design

Project Summary/Abstract Stomach or gastric cancer is the fifth most common cancer and the third leading cause of cancer mortality in the world, with a disproportionate burden experienced among Asians globally and Asian Americans in the US. Stomach cancer incidence among Chinese Americans is nearly twice that of non-Hispanic whites. In New York City (NYC), Asian men have twice the stomach cancer mortality of non-Hispanic white men and Asian women have the highest rates across all racial/ethnic groups. The bacterium Helicobacter pylori (H. pylori) is the strongest risk factor for stomach cancer. Up to 75% of all stomach cancer cases in the US present with late- stage disease, underscoring the need for more prevention and early detection. H. pylori eradication through triple antibiotic therapy is the most effective prevention method, however, it requires patient education and provider support to yield high adherence, especially for limited English and low health literacy populations. Many patients at high risk for stomach cancer enter primary care and endoscopy clinics for dyspepsia symptoms associated with H. pylori, thus representing a key window for prevention. H. pylori eradication efforts in the US, however, are limited in practice and poorly integrated within health systems. Health information technology (HIT) and community health worker (CHW)-led interventions have demonstrated effectiveness in improving screening, treatment, and follow-up care to bridge this gap, yet no studies have investigated the impact of integrating these strategies into a test-and-treat H. pylori approach. Led by Dr. Simona Kwon, the study goal of this full Research Project is to assess the efficacy, adoption, and impact of an integrated intervention to improve adherence to recommended stomach cancer prevention guidelines for at-risk, limited English proficient, low-income Chinese Americans in NYC. The integrated multifaceted theory-based intervention involves: 1) a health systems-level intervention using electronic health record (EHR)-based tools to facilitate H. pylori test-and-treat strategies; and 2) a theory-informed culturally and linguistically adapted CHW-led patient navigation program. Using a two-arm randomized controlled trial design, we will enroll 144 Chinese American patients across NYC safety net hospital settings to achieve the following specific aims: 1) Collaboratively develop an EHR- based clinical decision support system and a CHW-led culturally and linguistically adapted stomach cancer prevention program to improve H. pylori eradication for the LEP, Chinese American patients; 2) Implement and assess the efficacy of a H. pylori test-and-treat EHR-CHW intervention; and 3) Use a mixed-methods approach and the RE-AIM evaluation framework to systematically assess the implementation process and delineate factors that influence feasibility, acceptability, adoption, sustainability, and scalability of a combined EHR-CHW strategy within safety net health care systems.

项目摘要/摘要 胃癌或胃癌是第五大癌症，也是癌症死亡率的第三主要原因 世界上，全球亚洲人和美国的亚裔美国人承担着不成比例的负担。 华裔美国人的胃癌发病率几乎是非西班牙裔白人的两倍。在纽约 城市（纽约），亚洲男性的胃癌死亡率是非西班牙裔白人和亚洲妇女的两倍 在所有种族/族裔群体中的利率最高。细菌幽门螺杆菌（H. Pylori）是 胃癌的最强危险因素。在美国，多达75％的胃癌病例中有晚期 舞台疾病，强调需要更多的预防和早期检测。 H. Pylori消除 三重抗生素疗法是最有效的预防方法，但是，它需要患者教育和 提供者的支持以产生高度的依从性，尤其是对于有限的英语和低健康素养人群。 许多患胃癌高风险的患者进入初级保健和内窥镜诊所，患有困难 与幽门螺杆菌相关的症状，因此代表了预防的关键窗口。 H. Pylori消除工作 但是，在美国，实践中的局限性很少，并且整合在卫生系统中。健康信息 技术（HIT）和社区卫生工作者（CHW）领导的干预措施在 改善筛查，治疗和后续护理以弥合这一差距，但没有研究调查 将这些策略整合到幽门螺杆菌方法中的影响。 由Simona Kwon博士领导，该完整研究项目的研究目标是评估功效，采用和 综合干预措施的影响以提高对建议的胃癌预防的依从性 纽约市高危，有限的英国熟练，低收入美国人的指南。集成 基于理论的多方面干预涉及：1）使用电子健康的卫生系统级干预 记录（EHR）基于促进幽门螺杆菌测试和治疗策略的工具； 2）一种理论在文化上和 语言改编的CHW领导的患者导航计划。 使用两臂随机对照试验设计，我们将在遍布144名美国人患者 NYC安全网医院设置以实现以下特定目的：1）协作开发EHR- 基于临床决策支持系统以及CHW领导的文化和语言适应性胃癌 预防计划，以改善LEP，美国美国患者的消除幽门螺杆菌； 2）实施和 评估幽门螺杆菌测试和治疗EHR-CHW干预的功效； 3）使用混合方法方法 以及重新评估框架，以系统地评估实施过程并描述 影响联合EHR-CHW的可行性，可接受性，采用，可持续性和可扩展性的因素 安全网卫生保健系统中的策略。