Population Management for Hereditary Cancer Prevention: Implementation, Effectiveness, and Acceptability within a Learning Health System.

遗传性癌症预防的人口管理：学习健康系统内的实施、有效性和可接受性。

• 批准号: 10163248
• 负责人: Sarah Knerr
• 金额: $ 13.59万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-05-09
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10163248
• 关键词: Administrator; Adoption; Advisory Committees; Applications Grants; Area; Award; Breast Cancer Detection; Cancer Control; Career Mobility; Case Study; Chemoprevention; Clinical; Companions; Consolidated Framework for Implementation Research; Counseling; Data; Disease; Doctor of Philosophy; Education; Effectiveness; Electronic Health Record; Ethnography; Family Cancer History; Follow-Up Studies; Foundations; Funding; Future; Genetic; Genetic Counseling; Genetic Services; Genomic medicine; Genomics; Goals; Guidelines; Health; Health Services; Health Services Research; Health Status; Health system; Healthcare; Healthcare Systems; Healthy People 2020; Hereditary Breast and Ovarian Cancer Syndrome; Hereditary Malignant Neoplasm; High Risk Woman; Individual; Integrated Health Care Systems; Interdisciplinary Study; Interruption; Intervention; Interview; K-Series Research Career Programs; Learning; Literature; Longitudinal Studies; Mentors; Methods; Mutation; Operative Surgical Procedures; Outcome; Pacific Northwest; Pathogenicity; Patients; Population; Preventive service; Primary Health Care; Primary Prevention; Process; Program Evaluation; Provider; Public Health; Quality of life; Quasi-experiment; Research; Research Design; Research Personnel; Research Project Grants; Resources; Risk; Risk Assessment; Risk Factors; Risk Management; SECTM1 gene; Sampling; Scientist; Screening for Ovarian Cancer; Screening for cancer; Series; Service provision; Services; Structure; System; Testing; Time; Time Series Analysis; Training; Training Activity; Translating; Translations; United States; Universities; Washington; Woman; Work; aged; base; cancer genetics; cancer genomics; cancer prevention; cancer risk; care delivery; care providers; career; career development; clinical decision support; clinical infrastructure; clinical practice; cost; design; experience; follow-up; genetic testing; health care delivery; high risk; implementation barriers; implementation determinants; implementation facilitators; implementation science; implementation strategy; improved; informant; novel; patient registry; population based; population health; professor; programs; prophylactic; public health relevance; referral services; response; routine screening; satisfaction; screening guidelines; screening program; service providers; service utilization; skills; testing uptake; theories; tool; trend; uptake

PROJECT SUMMARY/ABSTRACT The objective of this Mentored Clinical Scientist Research Career Development Award (K08) is to provide Dr. Sarah Knerr with training, mentoring, research experience, and protected time to transition her career into genomic medicine and develop into an independent academic researcher. Dr. Knerr has an MPH in public health genetics and a PhD in health services research. She is currently Acting Assistant Professor, University of Washington Department of Health Services. Her career goals include: (1) conducting health services research that increases the generalizability and relevance of the genomic medicine literature, (2) becoming an expert in evaluating genomic health care delivery interventions, (3) using implementation science tools to accelerate genomic translation, and (4) obtaining funding to support an interdisciplinary research career. The didactic and experiential training activities outlined in this three-year K08 award will thus provide her with essential skills in leading pragmatic research within learning health care systems, evaluating health care programs using quasi-experimental designs, applying implementation science theories and methods to genomic health care delivery, and developing competitive grant applications. The complementary research project leverages the launch of a hereditary breast and ovarian cancer (HBOC) population management program within the Kaiser Permanente Washington (KPWA) health system. Building on Dr. Knerr’s prior work studying BRCA test utilization trends within KPWA, and through the following specific aims, the proposed study will generate novel data about the implementation, effectiveness, and acceptability of population-focused health care delivery programs in hereditary cancer genomics. Aim 1 will identify program implementation barriers and facilitators using ethnographic observation, document review, and key informant interviews. Aim 2 will use interviews to investigate patient experiences, satisfaction, and informational needs in the context of a clinical HBOC population management program. Aim 3 will determine program effects on genetic counseling referral and genetic services utilization within the KPWA population using routinely collected administrative data and an interrupted time series study design. This work supports current national priorities in genomic medicine and hereditary cancer prevention and control. Study findings can inform the implementation of genomic screening programs across disease areas, developing the clinical infrastructure needed to translate genomic advances into population-level health improvements. An outstanding team of mentors and advisors with expertise in genomic medicine, cancer prevention and control, implementation science, health program evaluation, and interrupted time series analysis will support Dr. Knerr in her training and research goals. The K08 activities lay the foundation for future R-level applications focused on refining and testing implementation strategies and supports for HBOC population management programs as well as follow-up studies of long-term program outcomes (e.g., risk-management uptake, quality of life, costs) within the KPWA system.

项目概要/摘要 该导师临床科学家研究职业发展奖（K08）的目的是为博士提供指导。 Sarah Knerr 拥有培训、指导、研究经验和受保护的时间，可将她的职业生涯转变为 基因组医学并发展成为一名独立学术研究员，Knerr 博士拥有公共公共卫生硕士学位。 她拥有健康遗传学和健康服务研究博士学位，目前是大学代理助理教授。 她的职业目标包括：(1) 开展卫生服务。 提高基因组医学文献的普遍性和相关性的研究，（2）成为 评估基因组医疗保健提供干预措施的专家，(3) 使用实施科学工具 加速基因组翻译，(4) 获得资金支持跨学科研究事业。 因此，为期三年的 K08 奖项中概述的教学和体验式培训活动将为她提供 在学习医疗保健系统、评估医疗保健方面领导实用研究的基本技能 使用准实验设计的计划，应用实施科学理论和方法 基因组医疗保健服务，以及开发有竞争力的资助申请。 该项目利用遗传性乳腺癌和卵巢癌 (HBOC) 人口管理的启动 华盛顿凯撒医疗机构 (KPWA) 卫生系统内的项目以克纳尔博士之前的工作为基础。 研究 KPWA 内 BRCA 测试的使用趋势，并通过以下具体目标，拟议的研究 将生成有关以人口为中心的实施、有效性和可接受性的新数据 遗传性癌症基因组学的医疗保健提供计划的目标 1 将确定计划的实施。 使用人种学观察、文件审查和关键知情人访谈来消除障碍和促进因素。 将通过访谈来调查患者的体验、满意度和信息需求 临床 HBOC 人口管理计划的目标 3 将确定计划对遗传咨询的影响。 使用常规收集的行政数据在 KPWA 人群中进行转诊和遗传服务利用 这项工作支持当前国家基因组优先事项。 医学和遗传性癌症的预防和控制研究结果可以为实施提供信息。 跨疾病领域的基因组筛查计划，开发转化所需的临床基础设施 基因组学进步促进了人口层面的健康改善。 一支由导师和顾问组成的杰出团队。 拥有基因组医学、癌症预防和控制、实施科学、健康计划方面的专业知识 评估和中断时间序列分析将支持克纳尔博士实现她的培训和研究目标。 K08 活动为未来专注于改进和测试实施的 R 级应用奠定基础 HBOC人口管理计划的策略和支持以及长期跟踪研究 KPWA 系统内的计划成果（例如，风险管理的采用、生活质量、成本）。