Research Project 2

研究项目2

基本信息

批准号：
10738713
负责人：
karla unger
金额：
$ 17.34万
依托单位：
UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
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：
2023-09-20 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10738713
关键词：
Address Area Breast Breast Cancer Patient Breast Cancer Treatment Cancer Center Cancer Control Capital Caring Case Manager Cities Clinic Clinical Collaborations Consultations Country Diagnosis Diagnostic Diagnostic Services Face Focus Groups Funding Goals Government Health Care Costs Health Personnel Health system Healthcare Healthcare Systems Home Human Resources Hybrids Image Implementation readiness Income Institution Intervention Interview Language Latin American Malignant Neoplasms Mammographic screening Maps Measures Medical Mentors Mexican Mexico Outcome Pathology Patient-Focused Outcomes Patients Population Primary Care Protocols documentation Public Health Quality of life Randomized Rapid diagnostics Recommendation Research Project Grants Resources Structure Symptoms System Systems Integration Testing Time Uninsured Woman World Health Organization advanced disease breast cancer diagnosis cancer care cancer diagnosis care delivery cost design diagnostic platform effectiveness evaluation effectiveness outcome effectiveness/implementation study experience follow-up implementation barriers implementation design implementation facilitators implementation fidelity implementation outcomes implementation science implementation strategy improved innovation integrated care low and middle-income countries malignant breast neoplasm metropolitan mortality organizational readiness primary care clinic primary care setting programs rapid diagnosis screening treatment services uptake

项目摘要

Implementation of integrated care for rapid breast cancer diagnosis ABSTRACT Consistent with the second pillar of WHO's Global Breast Cancer Initiative for improving breast cancer (BC) control in LMICs, our long-term goal is to improve the timeliness of breast cancer diagnosis in Mexico. The goal of the proposed study is to develop and test implementation strategies designed to improve integrated care for rapid BC diagnosis across health system levels among women presenting with BC in primary care settings. The Specific Aims are: (1) Assess barriers, facilitators, and organizational readiness for implementation of rapid BC diagnosis system. We will conduct qualitative interviews with healthcare personnel (informed by CFIR and ISF frameworks) to identify barriers and facilitators for implementation. Also, we will cross culturally adapt the R=MC 2 measure and assess organizational readiness across the 166 primary care centers that serve the uninsured population in Monterrey, Nuevo León. (2) Develop strategies to improve the implementation of a rapid BC diagnosis system. Using Implementation Mapping in collaboration with the key stakeholders, we will design contextually appropriate implementation strategies (including practice facilitation) to address barriers and strengthen organizational readiness for implementation of integrated care that will enable rapid diagnosis. (3) Evaluate the impact of practice facilitation on implementation of a rapid BC diagnosis system and determine effectiveness on patient outcomes. We will conduct a hybrid type 2 implementation-effectiveness study using a cluster randomized stepped-wedge design. Primary implementation outcome: reduction in the time between symptomatic presentation at the primary care clinics and arrival to the diagnostic clinic. Effectiveness outcome: down-shift in the stage of BC. The proposed study will address a pressing need in BC control in Mexico (and other LMICs), and advance implementation science by adapting and validating a Spanish language organizational readiness measure and evaluating the use of practice facilitation to improve readiness for implementation of cancer control practice change in LMICs.

实施乳腺癌快速诊断的综合护理抽象的符合世卫组织全球乳腺癌倡议的第二个支柱，即改善乳腺癌中低收入国家乳腺癌 (BC) 控制，我们的长期目标是提高控制的及时性拟议研究的目标是开发和测试墨西哥的乳腺癌诊断。旨在改善快速 BC 综合护理的实施策略对小学阶段患有 BC 的女性进行跨卫生系统层面的诊断护理设置的具体目标是： (1) 评估实施的障碍、促进因素和组织准备情况我们将对医疗保健进行定性访谈。人员（由 CFIR 和 ISF 框架通知）识别障碍和促进因素此外，我们还将跨文化地调整 R=MC 2 衡量标准并进行评估。为未参保人群提供服务的 166 个初级保健中心的组织准备情况新莱昂州蒙特雷的人口 (2) 制定改善的战略。使用实施映射实施快速 BC 诊断系统。与主要利益相关者合作，我们将设计适合环境的实施战略（包括促进实践）以解决障碍和加强实施综合护理的组织准备，这将 (3) 评估实践促进的影响。实施快速 BC 诊断系统并确定对患者的有效性我们将使用以下方法进行混合类型 2 实施效果研究。聚类随机阶梯楔形设计的主要实施结果：减少。在初级保健诊所出现症状和到达诊断诊所的有效性结果：BC 阶段的下移。研究将解决墨西哥（和其他中低收入国家）BC控制的迫切需求，以及通过调整和推进验证西班牙语来实现科学组织准备情况衡量和评估实践促进的使用提高中低收入国家实施癌症控制实践变革的准备程度。