Women in Survivorship Healthcare (WISH): Implementation of a Nurse Navigation Model for Medically Underserved Breast and Gynecologic Cancer Survivors using Project ECHO

女性幸存者医疗保健 (WISH)：使用 ECHO 项目为医疗服务不足的乳腺癌和妇科癌症幸存者实施护士导航模型

• 批准号: 10021610
• 负责人: Andrew Louis Sussman
• 金额: $ 19.77万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10021610
• 关键词: Address; American Cancer Society; American Society of Clinical Oncology; Cancer Model; Cancer Survivor; Cancer Survivorship; Caring; Communication; Communities; Community Healthcare; Community Medicine; Companions; Competence; Comprehensive Cancer Center; Continuity of Patient Care; Counseling; Data Collection; Diagnosis; Discipline of obstetrics; Educational Curriculum; Effectiveness; Endometrial Carcinoma; Ensure; Environment; Face; Family Practice; Funding Opportunities; General Practices; Geriatrics; Guidelines; Gynecology; Health; Health Services Accessibility; Healthcare; Healthcare Systems; Institute of Medicine (U.S.); Internal Medicine; Knowledge; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Measures; Modeling; New Mexico; Nurses; Oncologist; Outcome; Patient Care; Patients; Population Growth; Population Heterogeneity; Preventive; Primary Health Care; Process; Provider; Recommendation; Reporting; Research; Research Personnel; Research Support; Risk stratification; Role; Rural Minority; Service delivery model; Specialist; Testing; Training; Universities; Woman; adverse outcome; aging population; base; cancer therapy; cancer type; care outcomes; care providers; cohort; comorbidity; ethnic diversity; expectation; experience; feasibility trial; follow-up; geographic population; improved; innovation; large scale data; malignant breast neoplasm; medically underserved; meetings; member; multidisciplinary; novel; older patient; oncology service; patient oriented; preference; primary care setting; provider networks; recruit; screening; socioeconomic disparity; socioeconomics; standard of care; survivorship; systematic review; treatment planning

Project Summary/Abstract There are currently over 15 million cancer survivors in the US and this number is expected to exceed 20 million by 2026 due to population aging and growth. In 2006, the Institute of Medicine (IOM) released a landmark report outlining recommendations, including use of a survivorship care plan (SCP) to address the needs of cancer survivors, and other organizations have issued guidelines to improve survivorship care. Despite this recognition, research clearly documents the persistence of unmet needs among cancer survivors including less than optimal preventive and cancer surveillance screening rates. Several barriers have been identified in the effort to achieve optimal survivorship care: the current health care system is fragmented, difficult to navigate and communication between oncologists and primary care providers is often minimal. Further, a predicted shortage of oncologists/oncology services in relation to increases in cancer survivors highlights the need for alternative solutions. These circumstances underscore the urgent need to develop more effective models of care integration. The IOM, American Cancer Society and the American Society of Clinical Oncology all emphasize the importance of enhancing the role of primary care providers (PCPs)–general practice, family practice, obstetrics and gynecology, geriatrics, and internal medicine–in survivorship care. The use of SCPs is increasingly common, yet research has demonstrated implementation barriers that limit their effectiveness. Despite research aimed at implementing integrated care models, systematic reviews conclude that no standard of care exists for survivorship models. Encouragingly, studies have shown no differences in adverse outcomes of patients cared for by PCPs as compared to oncologists for certain cancer types. Prior research conducted by members of our research team, which serves as the basis for this proposal, found that both PCPs and patients are willing to participate in a survivorship care model. New Mexico, a large, rural, minority- majority state, with deep socioeconomic disparities that limit access to care, presents an ideal environment to advance implementation of SCPs in a broader integrated care model. In order to systematically develop and implement a survivorship care model, we have convened a partnership between community-based primary care providers, researchers and clinicians in the University of New Mexico Comprehensive Cancer Center (UNMCCC) and Departments of Family and Community Medicine, Obstetrics and Gynecology, and Project ECHO (Extension for Community Healthcare Outcomes), an innovative telementoring platform. The overall objective of the ECHO Women in Survivorship for Health (WISH) study is to implement and assess a survivorship care model by training a network of primary care providers through Project ECHO and then transitioning patients through nurse navigation and coordinated follow-up with a multidisciplinary specialist care team at the UNMCCC.

项目概要/摘要 目前美国有超过 1500 万癌症幸存者，预计这一数字将超过 2000 万 由于人口老龄化和人口增长，到 2026 年，医学研究所 (IOM) 发布了一项里程碑式的报告。 报告概述了建议，包括使用幸存者护理计划（SCP）来满足 尽管如此，癌症幸存者和其他组织仍然发布了改善幸存者护理的指南。 认识到，研究清楚地记录了癌症幸存者中持续存在的未满足的需求，包括较少 已经发现了一些障碍。 努力实现最佳生存护理：当前的医疗保健系统支离破碎，难以驾驭 此外，肿瘤科医生和初级保健提供者之间的沟通通常很少。 与癌症幸存者增加相关的肿瘤科医生/肿瘤学服务的短缺凸显了需要 替代解决方案。 这些情况强调迫切需要开发更有效的护理整合模式。 IOM、美国癌症协会和美国临床肿瘤学会都强调 加强初级保健提供者（PCP）作用的重要性——全科医学、家庭医学、产科 妇科、老年病学和内科——在幸存者护理中 SCP 的使用越来越多。 常见，但研究表明实施障碍限制了其有效性。 尽管研究旨在实施综合护理模式，但系统评价得出的结论是，没有 令人鼓舞的是，研究表明生存模型的护理标准没有差异。 与肿瘤科医生对某些癌症类型的先前研究相比，PCP 护理的患者的结果。 我们的研究团队成员进行了这项提案的基础研究，结果发现， 新墨西哥州是一个大型农村少数民族，PCP 和患者愿意参与幸存者护理模式。 多数国家的社会经济差距很大，限制了获得护理的机会，但为医疗服务提供了理想的环境 在更广泛的综合护理模式中推进 SCP 的实施，以便系统地开发和实施。 为了实施幸存者护理模式，我们在社区初级小学之间建立了伙伴关系 新墨西哥大学综合癌症中心的护理人员、研究人员和支持者 (UNMCCC) 以及家庭和社区医学、妇产科和项目部门 ECHO（社区医疗保健成果扩展），一个创新的远程指导平台。 ECHO 女性健康幸存者 (WISH) 研究的目标是实施和评估 通过 ECHO 项目培训初级保健提供者网络，然后建立幸存者护理模式 通过护士导航和多学科专科护理的协调随访来帮助患者过渡 UNMCCC 团队。