Applying Population Management Best Practices to Preventive Genomic Medicine

将人口管理最佳实践应用于预防性基因组医学

基本信息

批准号：
10674202
负责人：
Sarah Knerr
金额：
$ 94.95万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-05-10 至 2028-02-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10674202
关键词：
Address Adherence Adopted Caring Case Manager Chemoprevention Clinical Clinical Management Costs and Benefits Data Dedications Education Effectiveness Effectiveness of Interventions Ensure Ethnic Origin Evaluation Federally Qualified Health Center Genomic medicine Genomics Geography Goals Guidelines Health Health system Healthcare Systems Hereditary Malignant Neoplasm Hybrids Improve Access Individual Information Systems Infrastructure Inherited Integrated Health Care Systems Intervention Investments Language Link Longevity Malignant Neoplasms Morbidity - disease rate National Human Genome Research Institute Oncogenes Operative Surgical Procedures Patients Population Preventive Provider Quality of life Recommendation Recording of previous events Research Research Activity Resources Risk Risk Management Risk Reduction Safety Screening for Ovarian Cancer Screening for cancer Self Management Strategic vision Systems Integration Technology Testing Time Touch sensation World Health actionable mutation cancer genetics cancer genomics cancer risk compare effectiveness cost design diabetes management disorder risk education resources effectiveness outcome empowerment evidence base follow-up genetic risk factor genetic testing hereditary risk high risk high risk population implementation cost implementation intervention implementation outcomes implementation process improved improved outcome innovation mortality neoplasm registry online resource outreach patient engagement patient outreach patient registry patient safety programs prophylactic public health relevance racial diversity randomized trial screening shared decision making socioeconomics therapy design tool treatment as usual web site

项目摘要

PROJECT SUMMARY/ABSTRACT Preventive genomic medicine, particularly identification of individuals with inherited cancer risk, provides health systems with the opportunity to improve longevity and quality of life for their patients. The ability to uncover substantially elevated risk of disease through genomic testing, act to reduce that risk, and improve outcomes while lowering costs has been the longstanding promise of genomic medicine. In the case of inherited cancer, however, adherence to recommended risk management following genomic testing is low. Further, our pilot data suggests that health systems are reluctant to expand cancer genomic testing without a clearer idea of how to manage tested patients over time. Our goal in this application is to address this roadblock to genomic medicine implementation. Specifically, we will demonstrate the benefits that adopting population management interventions following genomic testing can provide health systems, using hereditary cancer as a case example. We will revise and rigorously evaluate two population management interventions (web resources and personalized outreach) that improve timely patient outreach and end-to-end tracking without burdening providers. Web resources is a low-touch intervention that links patients with existing educational resources (e.g., the Facing Our Risk of Cancer Empowered website). Personalized outreach is a high-touch intervention that connects patients with a dedicated care manager to discuss risk management and provide care reminders. Both interventions are highly scalable and mirror population management programs that health systems have used to support cancer screening, diabetes management, and other evidence-based care for decades. We will compare web resources and personalized outreach to usual care in a pragmatic hybrid type-1 randomized trial that engages patients captured in hereditary cancer registries within two health systems, Kaiser Permanente Northwest (KPNW) and Denver Health (DH). KPNW is a vertically integrated health system and DH is a federally qualified health center, providing two highly unique evaluation settings. Our primary effectiveness outcome is the proportion of registry patients up to date with recommended cancer screening over two years. We will collect secondary implementation outcomes, including the acceptability, appropriateness, feasibility, sustainability, and costs of high- and low-touch intervention approaches. By providing clinical champions with essential data and tools to select and implement population management interventions that address critical gaps in post-testing quality and patient safety, this innovative project will advance preventive genomic medicine.

项目概要/摘要预防性基因组医学，特别是识别具有遗传性癌症风险的个体，可以提供健康系统有机会提高患者的寿命和生活质量。揭开的能力通过基因组测试大幅提高疾病风险，采取行动降低风险并改善结果而降低成本一直是基因组医学的长期承诺。在遗传性癌症的情况下，然而，基因组检测后对建议的风险管理的遵守率很低。此外，我们的飞行员数据表明，如果没有更清晰的认识，卫生系统不愿意扩大癌症基因组检测如何随着时间的推移管理接受测试的患者。我们在此应用中的目标是解决基因组学的这一障碍医药实施。具体来说，我们将展示采用人口管理的好处以遗传性癌症为例，基因组测试后的干预措施可以为卫生系统提供帮助例子。我们将修订并严格评估两项人口管理干预措施（网络资源和个性化外展），可以改善及时的患者外展和端到端跟踪，而不会造成负担提供商。网络资源是一种低接触干预措施，将患者与现有教育资源联系起来（例如，“面对癌症风险”网站）。个性化外展是一种高接触性干预将患者与专门的护理经理联系起来，讨论风险管理并提供护理提醒。这两种干预措施都具有高度可扩展性，并反映了卫生系统的人口管理计划数十年来一直用于支持癌症筛查、糖尿病管理和其他循证护理。我们将在一项实用的混合 1 型随机试验中比较网络资源和个性化外展与常规护理涉及两个卫生系统内遗传性癌症登记处捕获的患者，Kaiser Permanente 西北航空 (KPNW) 和丹佛健康局 (DH)。 KPNW 是一个垂直整合的卫生系统，而 DH 是一个联邦合格的健康中心，提供两种高度独特的评估设置。我们的主要功效结果是登记处患者在两年内接受建议的癌症筛查的比例。我们将收集二次实施结果，包括可接受性、适当性、可行性、可持续性以及高接触和低接触干预方法的成本。通过为临床冠军提供选择和实施人口管理干预措施以解决关键问题的基本数据和工具检测后质量和患者安全方面的差距，这一创新项目将推进预防性基因组学药品。