Leveraging Health Systems to Increase Implementation of Evidence-based Surgical Cancer Care

利用卫生系统加强循证癌症外科护理的实施

• 批准号: 10722091
• 负责人: Kristy Kummerow Broman
• 金额: $ 19.72万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722091
• 关键词: Address; Adopted; Adoption; Alabama; Attention; Award; Cancer Patient; Caring; Characteristics; Clinical; Complement; Complex; Consultations; Cutaneous Melanoma; Data; Data Science; Decentralization; Deimplementation; Dissemination and Implementation; Ensure; Equity; Evidence based practice; Future; Goals; Health Services; Health care facility; Health system; Hospitals; Improve Access; Integrated Health Care Systems; Intervention; Interview; Investments; Joints; Knowledge; Level of Evidence; Link; Location; Logic; Malignant Neoplasms; Malignant neoplasm of esophagus; Malignant neoplasm of pancreas; Malignant neoplasm of prostate; Malignant neoplasm of thyroid; Medicare; Mission; Modeling; Needs Assessment; Operative Surgical Procedures; Ownership; Patient-Focused Outcomes; Patients; Penetration; Performance; Population; Process; Provider; Quality of Care; Research; Research Methodology; Research Personnel; Resources; Rural; Rural Population; Science; Site; Solid Neoplasm; Structure; System; Theoretical model; Training; United States; United States National Institutes of Health; Universities; Variant; Vulnerable Populations; Work; advanced analytics; analytical method; biomedical referral center; cancer care; cancer health disparity; cancer risk; cancer surgery; cancer therapy; care coordination; care delivery; care outcomes; common treatment; cost; design; effective therapy; evidence base; health care availability; health care delivery; health care disparity; health care service organization; implementation science; implementation strategy; improved; ineffective therapies; intervention mapping; malignant breast neoplasm; medical specialties; multilevel analysis; novel; outcome disparities; programs; remote location; secondary analysis; surgical risk; therapy design; treatment effect

PROJECT SUMMARY Hospitals are increasingly consolidating into health systems with shared ownership and management. Care in a health system has potential benefits for surgical cancer patients including improved access, care coordination, and strategies to disseminate and implement a rapidly evolving evidence-base into practice across system hub and spoke sites. Prior research has demonstrated that these potential benefits remain elusive. The impact of consolidation on quality varies widely, and there are disparate outcomes for surgical cancer patients treated at different facilities in the same systems. We have shown that location of surgical cancer care determines whether effective treatments are adopted (implementation) or ineffective treatments discontinued (de- implementation). We hypothesize that health system characteristics and strategies are associated with variability in implementation of oncologic evidence among hub and spoke hospitals and that through exploration of observed differences we will identify levers for targeted, multi-level interventions. This work addresses the NIH Blueprint objective to enhance research investments by ensuring adoption into practice and targets rural individuals, a population with disparate healthcare access and outcomes, who are often treated at spoke hospitals. We will examine the influence of treatment for common cancers in health system hubs and spokes on patient access and receipt of evidence-based care by linking SEER-Medicare data with health system data. Then, we will identify health system characteristics associated with evidence implementation, both quantitatively using multilevel modeling and qualitatively through structured interviews with health system stakeholders. Finally, we will use the resources within our Health System at the University of Alabama at Birmingham (UAB) to develop a system-level intervention for dissemination and implementation of oncologic evidence across hub and spoke sites. My long-term goal is to become an independent investigator who improves the quality of cancer care delivery by designing, implementing and studying health system-level interventions to increase clinical adoption of oncologic evidence. Through this training award, I will complement my health services and quality improvement science expertise with advanced training in the organization of healthcare delivery, multilevel analysis of secondary data, and implementation science to develop a system-level intervention to improve evidence-based surgical cancer care.

项目概要 医院越来越多地整合到卫生系统中，共享所有权和管理权。护理在 卫生系统对外科癌症患者具有潜在的好处，包括改善获取机会、护理协调、 以及在整个系统中心传播和实施快速发展的证据库的策略 和辐条站点。先前的研究表明，这些潜在的好处仍然难以捉摸。的影响 质量整合差异很大，接受治疗的外科癌症患者的结果也不同 同一系统中的不同设施。我们已经表明，癌症手术治疗的地点决定是否 采用有效的治疗（实施）或停止无效的治疗（去 执行）。我们假设卫生系统的特征和策略与变异性相关 在中心和辐射医院之间实施肿瘤学证据，​​并通过探索 根据观察到的差异，我们将确定有针对性的多层次干预措施的杠杆。 这项工作解决了 NIH 蓝图的目标，即通过确保采用来加强研究投资 实践并针对农村个人，这些人具有不同的医疗保健获取和结果，他们 经常在辐照医院接受治疗。我们将研究常见癌症治疗对卫生系统的影响 通过将 SEER-Medicare 数据与患者获取和接受循证护理相关的中心和辐条 卫生系统数据。然后，我们将确定与证据相关的卫生系统特征 实施，既使用多层次建模进行定量，又通过结构化访谈进行定性 卫生系统利益相关者。最后，我们将利用大学卫生系统内的资源 阿拉巴马州伯明翰分校 (UAB) 将制定系统级干预措施，以传播和实施 跨中心和辐射站点的肿瘤学证据。 我的长期目标是成为一名独立研究者，通过以下方式提高癌症护理服务的质量 设计、实施和研究卫生系统层面的干预措施，以提高肿瘤学的临床应用 证据。通过这个培训奖，我将补充我的健康服务和质量改进科学 在组织医疗保健服务、二手数据多层次分析方面拥有高级培训的专业知识， 和实施科学来开发系统级干预措施以改善循证外科癌症 关心。