Administrative Supplements for the Implementation Science Centers in Cancer Control (ISC3): Advancing Health Equity through Implementation Science

癌症控制实施科学中心 (ISC3) 的行政补充：通过实施科学促进健康公平

• 批准号: 10727614
• 负责人: Sarah LeLeiko Cutrona
• 金额: $ 12.5万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-18 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10727614
• 关键词: Address; Administrative Supplement; Adoption; Cancer Control; Cancer health equity; Caring; Clinic; Clinical; Collaborations; Data; Documentation; Electronic Health Record; Equity; Financial Hardship; Goals; Health; Housing; Incidence; Individual; Inequity; Interview; Malignant Neoplasms; Measurement; Measures; Morbidity - disease rate; Oncology; Outcome; Patient-Focused Outcomes; Patients; Phase; Pilot Projects; Population; Provider; Randomized, Controlled Trials; Risk; Risk Factors; Screening procedure; Shapes; Structure; Testing; Transportation; cancer care; cancer therapy; evidence base; experience; food insecurity; forest; health equity; health inequalities; implementation science; implementation strategy; implementation study; improved; informant; mortality; screening; social; social health determinants

Project Summary Social determinants of health (SDOH), social risk factors, and unmet social needs have critical implications for shaping and exacerbating health and health inequities for cancer incidence, morbidity and mortality. There is a critical need for accurate and comprehensive approaches to understanding how SDOH impact the implementation of evidence-based cancer care, equitable cancer outcomes, and health equity. Reliable, widespread, and available measurement of individual-level SDOH for all patients is a critical first step in identifying those patients at greater risk for experiencing inequities and that have unmet social needs. In our Phase I ISC3 Administrative Supplement for Advancing Health Equity through Implementation Science, Wake Forest iDAPT ISC3 and Penn ISC3 collaborated to evaluate the recent deployment of an electronic health record (EHR) module called the Epic® SDOH Wheel (herein “the Wheel”). The Wheel includes 16 items (e.g., food insecurity, transportation needs, housing, financial strain) that address social risk factors and unmet social needs. Phase I was a pre-implementation study to document current rates of SDOH screening and identify gaps in delivery, to inform strategies for increasing equitable reach of SDOH screening. We found markedly low rates of adoption of SDOH screening by oncology care teams and limited reach to oncology patients. Nonetheless, our key informant interviews revealed a commitment to measuring and addressing SDOH by the oncology care teams and clinical leaders, as well as context-specific SDOH screening tools that oncology care teams used instead of the Wheel. Findings from Phase 1 inform our proposed Phase 2 implementation pilot study to increase SDOH screening in patients undergoing cancer treatment at our Centers. Specifically, in Aim 1, we will develop tailored implementation strategies for increasing reach, equity, and adoption of SDOH screening in patients with cancer across a diverse range of cancer care settings and populations through rigorous rapid assessment of oncology care teams’ setting in the proposed clinics); adaptation of existing SDOH screening tools, and identification of implementation strategies to increase timely and widespread assessment and documentation of SDOH screening in patients with cancer. In Aim 2, we will assess the impact of tailored implementation strategies on reach, equity, and adoption of SDOH screening in patients with cancer using electronic health record data. We will use semi-structured interviews to understand factors influencing reach, equity, and adoption of SDOH screening from the perspective of patients, providers and staff. We will use findings from the proposed study to develop an R01 application for a randomized controlled trial to test the effect of CD2 on SDOH screening reach, equity, and adoption and subsequent efforts to address persistent or emergent social needs with the overarching goal of optimizing patient outcomes and improving cancer health equity.

项目摘要 卫生的社会决定者（SDOH），社会风险因素和未满足的社会需求对 癌症发病率，发病率和死亡率的塑造和加剧健康和健康不平等。有一个 对准确，全面的方法的批判性需求，以了解SDOH如何影响 实施基于证据的癌症护理，公平的癌症结果和健康公平。可靠的， 所有患者的宽度和可用的个人级SDOH的可用测量是关键的第一步 识别那些患有不平等的风险和未满足社会需求的患者。在我们的 I阶段ISC3行政补充剂，用于通过实施科学，唤醒来提高健康公平 森林IDAPT ISC3和Penn ISC3合作评估了最近部署电子健康记录 （EHR）称为EPIC®SDOH车轮的模块（本文“ the Wheel”）。车轮包括16个物品（例如，食物 解决社会风险因素和未满足社会的不安全感，运输需求，住房，财务压力） 需要。第一阶段是一项预料前研究，用于记录当前的SDOH筛选率并确定差距 在交付中，以告知策略以增加SDOH筛查的公平范围。我们发现价格明显低 通过肿瘤学护理团队对SDOH筛查的采用以及对肿瘤学患者的影响力有限。尽管如此， 我们的主要线人访谈揭示了肿瘤学护理测量和解决SDOH的承诺 团队和临床领导者，以及肿瘤学团队使用的特定环境SDOH筛查工具 而不是方向盘。第1阶段的发现告知我们拟议的2阶段实施试点研究以增加 在我们的中心接受癌症治疗的患者的SDOH筛查。具体来说，在AIM 1中，我们将发展 量身定制的实施策略，以增加覆盖范围，公平性和采用SDOH筛查的患者 通过严格评估 肿瘤学护理团队在拟议的诊所中的设置）；改编现有SDOH筛选工具，并 识别实施策略，以增加及时和宽度评估和文档 癌症患者的SDOH筛查。在AIM 2中，我们将评估量身定制的实施策略的影响 通过电子健康记录数据，癌症患者的SDOH筛查在触及范围，公平和采用后。 我们将使用半结构化访谈来了解因素影响力，公平和采用SDOH 从患者，提供者和员工的角度筛查。我们将使用拟议的研究中的调查结果 为随机对照试验开发R01应用程序，以测试CD2对SDOH筛选覆盖范围的影响， 公平，适应和随后的努力，以解决持续或紧急的社会需求 优化患者预后并改善癌症健康公平的目标。