Implementing Universal Lynch Syndrome Screening across Multiple Healthcare Systems: Identifying Strategies to Facilitate and Maintain Programs in Different Organizational Contexts

在多个医疗保健系统中实施通用林奇综合症筛查：确定在不同组织环境中促进和维护计划的策略

• 批准号: 9384218
• 负责人: Alanna K Rahm
• 金额: $ 80.74万
• 依托单位: GEISINGER CLINIC
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9384218
• 关键词: Clinical; Colorectal Cancer; Colorectal Neoplasms; Complex; Computer Simulation; Custom; Data; Decision Analysis; Decision Making; Eligibility Determination; Endometrial; Engineering; Environment; Evaluation; Family history of; Family member; Genetic; Genetic Counseling; Genetic screening method; Genomic medicine; Genomics; Goals; Guidelines; Health; Healthcare; Healthcare Systems; Hereditary Nonpolyposis Colorectal Neoplasms; Individual; Inherited; Intervention; Interview; Lead; Life; Maintenance; Malignant Neoplasms; Medicine; Mismatch Repair; Mission; Modeling; Morbidity - disease rate; Newly Diagnosed; Organizational Decision Making; Outcome; Ovarian; Patients; Precision Medicine Initiative; Prevention; Process; Protocols documentation; Provider; Public Health; Publishing; Renal carcinoma; Reporting; Resources; Risk; Savings; Site; Stomach; Techniques; Testing; United States National Academy of Sciences; Variant; Work; base; cancer risk; cancer therapy; clinical practice; comparative; contextual factors; cost; design; economic impact; gene repair; health care delivery; implementation research; implementation science; improved; malignant small intestine tumor; member; mortality; new technology; organizational structure; patient population; practical application; precision medicine; prevent; programs; relative effectiveness; screening; systems research; tailored health care; tool; tumor; wasting; working group

Project Summary/Abstract Lynch syndrome (LS) is the most common form of inherited colorectal cancer risk. People with Lynch syndrome are also at increased risk for endometrial, ovarian, gastric, small bowel, and renal cancers. Importantly, well-established clinical guidelines with strong evidence exist for cancer treatment, screening, and prevention in individuals with LS. Identification of individuals with LS is accomplished through a variety of techniques, including family and medical history evaluation, computational models, or tumor testing. The systematic screening of all colorectal tumors for LS was first recommended by the Evaluation of Genetic Application in Practice and Prevention (EGAPP) working group in 2009 and has been designated high priority by the National Academies of Science, Engineering, and Medicine working group and by the Blue Ribbon Panel. The potential public health impact to reduce cancer morbidity and mortality of this intervention supports this priority, as effective implementation of LS screening will help meet the goals of the Cancer Moonshot as well as demonstrate the promise of precision medicine. Currently, implementation of LS screening in healthcare systems remains suboptimal for a variety of reasons. LS screening involves the coordination of multiple departments and individuals across an organization, which is often difficult in large, complex, healthcare systems. Therefore, the overarching goal of this project is to utilize tools from implementation science to describe, explain, and compare decision making and other variations in LS screening implementation across multiple healthcare systems to create and evaluate in a real world setting an organizational toolkit to facilitate implementation of LS screening. Our specific aims are to (1) Describe variation in LS screening implementation across multiple healthcare systems; then (2) Explain practice variation and determine factors associated with optimal implementation; and (3) Determine the relative effectiveness, efficiency, and costs of different LS screening protocols by healthcare system; and finally to (4) Develop and test in a natural environment an organizational toolkit for LS screening. This toolkit will enable effective implementation of LS screening programs; ultimately preventing needless suffering of patients and their family members from preventable cancers, decreasing waste in healthcare system costs, and informing strategies to facilitate the promise of precision medicine.

项目摘要/摘要 林奇综合征（LS）是遗传结直肠癌风险的最常见形式。有人 林奇综合征还具有子宫内膜，卵巢，胃，小肠和 肾脏癌。重要的是，存在良好的临床准则，有强有力的证据 LS患者的癌症治疗，筛查和预防。识别个人 使用LS通过各种技术来完成，包括家庭和病史 评估，计算模型或肿瘤测试。所有结直肠的系统筛选 首先，通过评估遗传应用在实践中，首先建议使用LS的肿瘤 2009年的预防（EGAPP）工作组，已被指定 国家科学，工程和医学工作组以及蓝色 色带面板。降低癌症发病率和死亡率的潜在公共卫生影响 干预支持此优先级，因为LS筛查的有效实施将有助于实现 癌症的目标以及证明精度医学的希望。 目前，医疗保健系统中LS筛查的实施仍然是最佳的 各种原因。 LS筛查涉及多个部门的协调 整个组织中的个人通常在大型，复杂，医疗保健系统中很困难。 因此，该项目的总体目标是利用从实施科学到 描述，解释和比较LS筛选中的决策和其他变化 跨多个医疗保健系统实施，以在现实世界中创建和评估 一个组织工具包，可促进实施LS筛选。我们的具体目的是（1） 描述多个医疗保健系统中LS筛查实施的变化；然后（2） 解释实践变化并确定与最佳实施相关的因素； （3） 确定不同LS筛选协议的相对有效性，效率和成本 医疗保健系统；最后（4）在自然环境中发展和测试一个组织 LS筛选的工具包。该工具包将有效实施LS筛选 程序；最终防止患者及其家人的不必要痛苦 可预防的癌症，减少医疗保健系统成本的废物，并告知策略 促进精密医学的承诺。