Evaluating Centralizing Interventions to Address Low Adherence to Lung Cancer Screening Follow-up in Decentralized Settings

评估集中干预措施，以解决分散环境中肺癌筛查随访依从性低的问题

基本信息

批准号：
10738120
负责人：
Matthew Adam Triplette
金额：
$ 56.01万
依托单位：
FRED HUTCHINSON CANCER CENTER
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：
2023-08-01 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10738120
关键词：
Achievement Address Adherence Black race Cancer Etiology Caring Cessation of life Clinic Clinical Clinical Trials Communities Comprehensive Cancer Center Comprehensive Health Care Consolidated Framework for Implementation Research Continuity of Patient Care Data Decentralization Diagnosis Disparate Disparity Dose Effectiveness Elements Eligibility Determination Ensure Equity Ethnic Origin Ethnography Evaluation Evidence based intervention Goals Guidelines Health Disparities Research Hispanic Populations Intervention Interview Knowledge Maintenance Malignant neoplasm of lung Managed Care Measures Multicenter Studies National Institute on Minority Health and Health Disparities Observational Study Pathway interactions Patient Care Patients Population Population Heterogeneity Process Provider Race Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reduce health disparities Research Resource-limited setting Rural Rural Population Screening for cancer Site Socioeconomic Status Standardization Structure System Testing Translating Translations United States United States National Institutes of Health Washington Work adherence rate arm care coordination care systems chest computed tomography clinical practice community partnership community setting disparity reduction effectiveness evaluation effectiveness measure effectiveness/implementation trial ethnic disparity ethnic diversity evidence base experience follow-up former smoker health disparity high risk implementation evaluation implementation framework implementation intervention improved innovation intervention program lung cancer screening mortality personalized approach pragmatic intervention primary care provider programs prospective racial disparity routine screening rural disparities rurality screening screening program socioeconomics standardized care therapy design urban disparity urban setting

项目摘要

PROJECT SUMMARY/ABSTRACT Lung cancer is the leading cause of cancer death in the United States, and lung cancer screening has been demonstrated to effectively reduce lung cancer by 20-26% in eligible patients. Despite 10 years of recommendations endorsing screening, evidence suggests that real-world implementation of screening along the care continuum has been poor. Specifically, prior work reveals that adherence to routine annual screening and specialized follow-up after positive lung cancer screening exams is suboptimal, with a median adherence of 40-60% across clinical programs. Follow-up after either negative or positive lung cancer screening is a critical target to achieve mortality benefits seen in clinical trials, as adherence to follow-up was >90% in these studies, and more than half of all screen-detected lung cancers were diagnosed in follow-up. Prior studies of adherence to follow-up been largely observational, single center and performed in academic settings, but have demonstrated that clinical lung cancer screening programs which contain centralized program-level interventions such as care coordination have two-to-three times the rate of follow-up adherence compared to programs where lung cancer screening is largely managed by primary providers. Prior observational work also suggests centralized programmatic interventions may mitigate health disparities in lung cancer screening. It is therefore critical to prospectively evaluate feasible and effective centralized program interventions in community settings to translate the benefits to screening programs and patients. To fill this important knowledge gap, the central objective of this study is to generate evidence of barriers and facilitators to lung cancer screening follow-up in decentralized community programs, adapt and introduce centralizing interventions in these settings and rigorously measure the effectiveness and implementation of these interventions. This objective will be met by achievement of three specific aims performed at 3 non- academic regional partnering sites with large rural and Hispanic populations. In the first aim, we will determine system-, provider- and patient-level facilitators to LCS follow-up in these settings using an innovative rapid ethnographic approach supplemented by semi-structure interviews. In the second aim, we will adapt and evaluate centralizing interventions including defined care pathways and after-screening care coordination measuring the impact on adherence and socioeconomic, rural-urban and racial-ethnic disparities. Finally in the third aim, we will evaluate the implementation of these strategies with a key focus on the tension between fidelity and adaptations as these interventions mature. The aims will be grounded in an integration of the Consolidative Framework of Implementation Research, RE-AIM and a NIH-developed health disparities framework. Our team has extensive experience in lung cancer screening implementation and disparities with expertise in adapting and evaluating pragmatic interventions in community settings. This project will generate essential knowledge to improve lung cancer screening follow-up in real-world clinical programs.

项目概要/摘要肺癌是美国癌症死亡的主要原因，肺癌筛查已经证明，可以有效地将符合条件的患者的肺癌减少 20-26%。尽管10年支持筛查的建议，有证据表明，在现实世界中实施筛查护理连续性很差。具体来说，之前的工作表明，遵守例行年度筛查肺癌筛查检查呈阳性后的专门随访效果不佳，依从性中等整个临床项目的 40-60%。肺癌筛查阴性或阳性后的随访是临床试验中观察到的实现死亡率获益的关键目标，因为这些试验中坚持随访的比例 >90% 研究发现，超过一半的筛查检测肺癌是在随访中确诊的。先前关于随访依从性的研究主要是观察性的、单中心的并且是在学术界进行的环境，但已证明临床肺癌筛查计划包含集中化护理协调等计划级干预措施的随访依从率提高了两到三倍与肺癌筛查主要由主要提供者管理的项目相比。事先的观察工作还表明，集中的计划性干预措施可以减轻不同地区的健康差距肺癌筛查。因此，前瞻性地评估可行且有效的集中化至关重要。在社区环境中进行计划干预，将好处转化为筛查计划和患者。为了填补这一重要的知识空白，本研究的中心目标是生成障碍的证据和分散社区计划中肺癌筛查后续工作的促进者，调整和引入在这些环境中集中干预，并严格衡量措施的有效性和实施情况这些干预措施。这一目标将通过在 3 个非组织中实现三个具体目标来实现。与大量农村和西班牙裔人口建立学术区域合作网站。在第一个目标中，我们将确定系统、提供者和患者层面的促进者在这些环境中使用创新的快速方法进行 LCS 随访人种学方法辅以半结构式访谈。在第二个目标中，我们将适应并评估集中干预措施，包括明确的护理途径和筛查后护理协调衡量对依从性和社会经济、城乡和种族民族差异的影响。最后在第三个目标，我们将评估这些战略的实施情况，重点关注之间的紧张关系随着这些干预措施的成熟，保真度和适应性也会随之提高。这些目标将立足于整合实施研究综合框架、RE-AIM 和 NIH 制定的健康差异框架。我们的团队在肺癌筛查实施方面拥有丰富的经验以及与其他国家的差异适应和评估社区环境中的务实干预措施的专业知识。该项目将生成改善现实临床项目中肺癌筛查随访的基本知识。