Clinical benefit and cost-efficacy of risk-stratified survivorship navigation to overcome structural barriers to long-term follow-up care

风险分层生存导航的临床效益和成本效益，以克服长期随访护理的结构性障碍

• 批准号: 10408928
• 负责人: HELEN E HESLOP
• 金额: $ 14.98万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10408928
• 关键词: Address; Adopted; Affect; Age-Years; Algorithms; Area; Awareness; Cancer Center; Caring; Chronic; Clinic; Clinical; Conflict (Psychology); Cost Analysis; Costs and Benefits; Counseling; Data; Development; Diagnosis; Diagnostic tests; Early Diagnosis; Education; Educational Background; Electronic Health Record; Elements; Environment; Failure; Future; Health; Hospitals; Hour; Human Resources; Income; Individual; Institutional Policy; Insurance; Intervention; Investigation; Laboratories; Language; Late Effects; Learning; Life; Life Style; Location; Long-Term Survivors; Longterm Follow-up; Maintenance; Measures; Medical; Methods; Morbidity - disease rate; Neighborhoods; Outcome; Patients; Perception; Policies; Population; Populations at Risk; Predictive Factor; Prevention; Privatization; Procedures; Publishing; Reporting; Resources; Risk; Risk Reduction; Schedule; Schools; Secondary Prevention; Socioeconomic Factors; Structure; Surveys; Survivors; System; Testing; Time; Travel; Visit; Work; barrier to care; base; cancer diagnosis; cancer therapy; care delivery; childhood cancer survivor; cost; deprivation; design; disadvantaged background; ethnic minority population; evidence base; experience; follow-up; health care service utilization; high risk; improved; intervention cost; metropolitan; novel; novel strategies; pandemic disease; personalized strategies; post intervention; preference; prospective; racial minority; relative cost; risk stratification; screening; sociodemographic factors; sociodemographics; socioeconomic disadvantage; socioeconomics; stem; survivorship; telehealth; tool; treatment risk; uptake; voucher

Despite a critical need for long-term follow-up care, only one-third of childhood cancer survivors (CCS) report receiving survivor-focused care, and even fewer receive risk-reduction counseling and appropriate screening. Numerous studies have described barriers experienced by CCS at the individual level, which largely stem from socioeconomic factors. As a result, at-risk populations have limited opportunities to engage in long-term follow- up care, placing them at higher risk for treatment-related morbidities. Few studies have successfully tested effective, sustainable interventions to overcome structural barriers within the cancer center environment, factors that contribute to CCS outcome disparities by limiting access to survivorship care. Equitable access to quality survivorship care cannot be achieved without addressing existing barriers to health care utilization. The objective of our proposal is to evaluate hospital policies and procedures that disproportionately impact CCS from disadvantaged backgrounds, and identify novel strategies that eliminate, circumvent, or overcome systematic barriers to CCS entry into long-term follow-up care. Aim 1 will leverage electronic health record data extraction tools to abstract relevant sociodemographic data from living CCS that have completed treatment. We will then develop an algorithm for identifying CCS at-risk for suboptimal health care utilization (defined as failure to enter long-term follow-up care by four years after completing treatment). To do this, we will use factors predictive of survivorship nonadherence from our previously published work, and incorporate area-based measures of socioeconomic deprivation. For Aim 2 we will prospectively identify CCS who are at-risk for suboptimal health care utilization and eligible for entry to long-term follow-up (at least 3 years from end of therapy) who have not yet scheduled a visit in the Long Term Survivor (LTS) Clinic. A Survivorship Navigator will contact at-risk CCS to complete a survey that assesses structural barriers, data that will be used to inform development of an LTS Resource Tool Kit. For Aim 3, the Survivorship Navigator will use the LTS Resource Tool Kit to offer at-risk CCS personalized solutions to the barriers they endorsed in Aim 2. Clinical benefit to the intervention will be assessed by comparing the rates of first LTS visit per eligible at-risk CCS to rates from historical at-risk CCS controls. The impact of the intervention on cost efficacy will be determined from the personnel time spent in navigation activities plus Tool Kit-related expenses to the resulting increase in revenue generated from LTS visits. We anticipate this project will improve the proportion of eligible at-risk CCS that initiate long-term follow-up care in the LTS Clinic. Evidence generated by the results of this study will provide practical, sustainable, and, most importantly, generalizable solutions that maximize survivorship care uptake in at-risk CCS. Future areas of investigation include assessment of the impact of this intervention on maintenance of long-term follow-up care beyond the initial visit.

尽管至关重要长期随访，但只有三分之一的儿童癌症幸存者（CCS）报告 接受以幸存者为中心的护理，甚至更少接受降低风险咨询和适当的筛查。 大量研究描述了CCS在个人层面上遇到的障碍，这主要源于 社会经济因素。结果，处于危险的人口有限的机会进行长期跟进的机会 - 加强护理，使他们面临与治疗相关的病毒率更高的风险。很少有研究成功测试 有效，可持续的干预措施以克服癌症中心环境中的结构障碍， 通过限制获得生存护理的访问来导致CCS结果差异的因素。 如果不解决现有的健康障碍，就无法实现公平获得优质的生存护理 护理利用。我们建议的目的是评估医院政策和程序 不成比例地影响不利背景的CC，并确定消除，消除， 绕过或克服了CCS进入长期随访护理的系统障碍。 AIM 1将利用 电子健康记录数据提取工具从活着的CC中抽象相关的社会人口统计学数据 已经完成治疗。然后，我们将开发一种用于识别CCS处于次优健康状况的算法 护理利用（被定义为在完成治疗后四年未能在长期进行长期随访）。 为此，我们将使用以前发表的工作中预测生存不遵守的因素，以及 结合基于地区的社会经济剥夺措施。对于目标2，我们将前瞻性地识别CCS 他们处于次优的医疗保健利用中，并有资格参加长期随访（至少3个） 从治疗结束后的几年）尚未安排长期幸存者（LTS）诊所的访问。一个 生存导航员将联系高危CCS，以完成评估结构性障碍的调查，数据 将用于告知LTS资源工具套件的开发。对于AIM 3，生存导航员将 使用LTS资源工具套件为AIM认可的障碍提供高危CCS个性化解决方案 2。将通过比较符合条件的高风险访问率来评估干预措施的临床益处 CCS从历史高危CCS控件中汇率。干预对成本效能的影响将是 从导航活动中花费的人员时间以及与工具包相关的工具套件的费用确定 LTS访问产生的收入增加。 我们预计该项目将改善启动长期随访的合格高风险CC的比例 LTS诊所的护理。这项研究结果产生的证据将提供实用，可持续性以及 最重要的是，可在高危CCS中最大化生存护理吸收的可概括解决方案。未来领域 调查包括评估这种干预对维持长期随访的影响 超越初次访问。