Effectiveness and implementation of a health system intervention to improve quality of cancer care for rural, underserved patients

卫生系统干预措施的有效性和实施，以提高农村、服务不足的患者的癌症护理质量

• 批准号: 10577873
• 负责人: MARY E. CHARLTON
• 金额: $ 60.01万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10577873
• 关键词: Accreditation; Address; Adopted; Adoption; American College of Surgeons; Area; Breast; Breast-Conserving Surgery; Cancer Center; Cancer Death Rates; Cancer Patient; Caring; Colon Carcinoma; Colorectal; Colorectal Cancer; Community Hospitals; Consolidated Framework for Implementation Research; Data; Data Collection; Diagnosis; Diffusion; Effectiveness; Familiarity; Goals; Guidelines; Health system; Healthcare; Home; Hospitals; Incidence; Infrastructure; Intervention; Intervention Trial; Interview; Iowa; Kentucky; Logistics; Malignant Neoplasms; Measures; Methods; Modeling; Monitor; Needs Assessment; Outcome; Patients; Pattern; Performance; Physicians; Population; Proctor framework; Qualifying; Quality of Care; Radiation therapy; Readiness; Research; Resected; Resource Sharing; Resources; Risk; Rural; Rural Hospitals; Rural Population; Services; Social support; Specialist; Specific qualifier value; Structure; Testing; Time; Transportation; United States; Universities; Urban Population; Woman; Work; adaptation algorithm; breast cancer diagnosis; cancer care; cancer health disparity; cancer therapy; cancer type; cost; data registry; disparity reduction; draining lymph node; evidence base; health difference; hospital care; implementation determinants; implementation outcomes; implementation process; implementation science; improved; malignant breast neoplasm; mortality; multidisciplinary; neoplasm registry; network models; novel; post intervention; preference; preservation; programs; psychosocial; rural area; rural cancer care; rural disparities; rural dwellers; rural patients; rural setting; survival outcome; survivorship; theories; tool; treatment guidelines; treatment planning

PROJECT SUMMARY There is growing evidence that limited access to high-quality cancer treatment is one of the main drivers of higher cancer mortality rates among rural cancer patients. Our analyses of Iowa Cancer Registry data indicate that 40% of rural patients with breast and colorectal cancers receive most or all definitive treatment in rural hospitals that do not collect or monitor data on their quality of cancer care, and are not accredited by the American College of Surgeons Commission on Cancer (CoC). Our data also shows these patients are less likely to receive guideline-concordant care. Given patients' needs and preferences to receive cancer care locally, a promising strategy to improve quality of cancer care and outcomes in rural populations is to intervene directly with the community hospitals in these areas. New evidence has demonstrated effectiveness of this approach: the Markey Cancer Center Affiliate Network (MCCAN) was formed by the University of Kentucky (UK) Markey Cancer Center to improve quality of cancer care in their own rural, low-resourced state, one that leads the nation in cancer incidence and mortality. Over the last decade MCCAN has facilitated the sharing and diffusion of resources and best practices throughout their network. As a result, affiliates markedly improved performance on established, cancer care quality measures and expanded their services (e.g., psychosocial and survivorship support). They were also almost 3 times more likely to obtain CoC accreditation than their matched controls. However, the MCCAN model has not been rigorously defined, evaluated or tested in any other setting. We propose to adapt this successful health system-level intervention for Iowa, establishing the Iowa Cancer Affiliate Network (I-CAN). Although there are similarities between Iowa and Kentucky's populations that suggest the MCCAN model may be a good fit, there are also significant differences in healthcare infrastructure and resources that require careful adaptation of the intervention prior to its implementation in order to retain its effectiveness. We will use novel, rigorously developed, theory-based implementation science methods to identify MCCAN's core functions (i.e., what makes it effective), study the implementation process and evaluate how I-CAN performs in a new context. We have identified 4 rural, Iowa hospitals to participate in this intervention trial and developed expert support teams to assist key stakeholder groups within each hospital. Through interviews and qualitative analyses, we will assess determinants and outcomes of the implementation process, and perceived value of the CoC accreditation standards and the intervention itself as a way to improve the quality of cancer care for their patients. We will compare compliance with treatment-related quality measures and the proportion of CoC standards of cancer care implemented in target and control hospitals, pre- and post-intervention using a difference-in-difference estimator. This work could lead to dissemination of similar models across rural settings thereby improving quality of care, reducing rural disparities in cancer outcomes and giving rural hospitals an avenue to demonstrate their quality of care.

项目摘要 越来越多的证据表明，获得高质量癌症治疗的机会是 农村癌症患者的癌症死亡率较高。我们对爱荷华州癌症注册表数据的分析表明 40％的乳房和结直肠癌的农村患者在农村地区接受大多数或全明确的治疗 未收集或监控数据的医院有关其癌症护理质量的数据，并且未被 美国外科医生学院癌症委员会（COC）。我们的数据还表明这些患者较少 可能会获得指导方案护理。考虑到患者接受癌症护理的需求和偏好 在当地，提高农村人口癌症护理质量和成果的有前途的策略是干预 直接与这些地区的社区医院一起。新证据证明了这一点 方法：肯塔基大学成立了Markey Cancer Center网络网络（MCCAN） （英国）Markey Cancer Center，以提高自己农村低资源的癌症护理质量，该州 领导国家的癌症发病率和死亡率。在过去的十年中，麦康促进了分享 以及整个网络中资源和最佳实践的扩散。结果，会员明显 改善了既定，癌症护理质量措施的绩效并扩大了服务（例如， 社会心理和生存支持）。他们获得COC认证的可能性也几乎是3倍 比他们匹配的控件。但是，麦卡模型尚未经过严格定义，评估或测试 在任何其他环境中。我们建议适应爱荷华州成功的卫生系统级干预措施，建立 爱荷华州癌症会员网络（I-CAN）。尽管爱荷华州和肯塔基州之间有相似之处 表明麦卡模型可能很合适的人群，在 医疗保健基础设施和资源需要在干预之前进行仔细调整 实施以保持其有效性。我们将使用小说，严格发展，基于理论的 实施科学方法来识别麦卡的核心功能（即使其有效的原因），研究 实施过程并评估I-CAN在新环境中的表现。我们已经确定了爱荷华州的4个农村 医院参加此干预试验并开发了专家支持团队，以协助关键利益相关者 每个医院内的小组。通过访谈和定性分析，我们将评估决定因素和 实施过程的结果，以及COC认证标准的感知价值和 干预本身是提高患者癌症护理质量的一种方式。我们将比较合规性 与治疗相关的质量指标以及在 目标和控制医院，使用差分差异估计量进行干预前后。这项工作 可能导致在农村环境中传播类似模型，从而提高护理质量，从而降低 癌症结局的农村差异，并为农村医院提供了证明其护理质量的途径。