Tackling Health Disparities: Improving Healthcare Delivery Systems - - PowerPoint PPT Presentation

Tackling Health Disparities: Improving Healthcare Delivery Systems for Cancer Care

Steve Clauser, PhD, MPA

Program Director

Alyzza Dill, MPH Program Associate

Healthcare Delivery & Disparities Research

Objectives

• Patient-Centered Comparative Effectiveness Research—

What is it?

• Engagement—How does PCORI engage patients &

stakeholders in research?

• Addressing Health Disparities & Improving Healthcare

Systems– What are we doing in intervention research to address cancer care disparities and improve health equity?

• Success—How does this approach work?
• Sustainability—What is next in bringing these interventions

to scale and making a difference in the lives of patients?

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Patient-Centered Comparative Effectiveness Research: What is it?

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About PCORI

Authorized by Congress as an independent research institute through the Patient Protection and Affordable Care Act. Funds comparative clinical effectiveness research (CER) that engages patients and

• ther stakeholders throughout the research

process. Seeks answers to real-world questions about what works best for patients based

• n their circumstances and concerns.

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How is Our Work Different?

• We fund research on which care options work, for

whom, under which circumstances.

• We focus on answering questions most important to

patients and those who care for them.

• We aim to produce evidence that can be easily

applied in real-world settings.

• We engage patients, caregivers, clinicians, insurers,

employers and other stakeholders throughout the research process.

• This makes it more likely we’ll get the research

questions right and that the study results will be useful and taken up in practice.

The Research We Fund is Guided by Our National Priorities for Research

Assessment of Prevention, Diagnosis, and Treatment Options Improving Healthcare Systems Communication & Dissemination Research Addressing Disparities Accelerating PCOR and Methodological Research

Healthcare Delivery and Disparities Research: Program Goals

• To support studies of the comparative effectiveness of alternate

features of healthcare systems designed to optimize the quality, access, outcomes, and/or efficiency of care for the patients they serve.

• To support comparative effectiveness research that will identify best
• ptions for reducing and eliminating disparities in health and

healthcare outcomes.

• To support studies that will provide information of value to

patients, their caregivers and clinicians, as well as to healthcare leaders, regarding which features of systems lead to better and equitable patient-centered outcomes.

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Engagement: How does PCORI engage stakeholders in research?

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Who Are Our Stakeholders?

Community Organizations Caregivers/Family Members Faith Based Organizations & Churches Patients/Consumers Clinicians Training Institutions Policy Makers Hospitals/Health Systems Industry Patient/Caregiver Advocacy Organizations

How We Engage Stakeholders

Advisory Panels Pipeline to Proposal Awards Webinars and Workshops Ambassadors Engagement Awards Merit Review Panels Speakers Bureau

Why Engage?

To influence research to be patient-centered, relevant, and useful To establish trust and a sense of legitimacy in research findings To encourage successful uptake and use of research results

Addressing Health Disparities & Improving Healthcare Systems: What are we doing in intervention research to address cancer care disparities and improve health equity?

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Health Delivery and Disparities Research: Framework

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National Health Policy Environment State Health Policy Environment Local Community Environment Organization and/or Practice Setting

Provider/Team Family & Social Supports

Individual Patient

Medicare reimbursement, Federal health reform, Accreditations, etc. Medicaid reimbursement, Hospital performance data, state health reform, etc. Community-based resources, Churches, Local hospital services, Local professional norms, etc. Communication skills, cultural competency, staffing mix, team culture, role definition, etc. Caregivers, Friends, Network support, Social Media, etc. Socio-demographics, Insurance coverage, Comorbidities, Patient care preferences, Behavioral factors, Cultural perspectives. Organizational leadership, Delivery system design, Clinical decision support, etc.

Disparities

S.H. Taplin et al “Introduction: Understanding and influencing multilevel factors across the cancer care continuum. JNCI 2012 May: 2012(44)

Cancer Health Disparities Research Challenges

• Cancer affects people of all backgrounds, however the burden is

greater for specific populations (e.g. racial/ethnic minorities, low- socioeconomic groups, people in geographically isolated areas).

• The communities that experience cancer health disparities are

also significantly underrepresented in cancer clinical trials.

• Cancer disparities research is needed to understand and address

why some groups are more likely to develop cancer, experience cancer-related health problems, or die from cancer more than other groups.

• Researchers are working to design and test interventions that

address the various drivers of disparities in different population groups.

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Healthcare Delivery and Disparities Research: Projects within Specific Health System Levels

National Health Policy Environment State Health Policy Environment Local Community Environment Organization and/or Practice Setting

Provider/Team

Family & Social Supports

Individual Patient

Eliminating Patient Identified Socio-legal Barriers to Cancer Care (PI: Tracy Battaglia) Evaluating the Impact of Patient-centered Oncology Care (PI: Sarah Scholle) Building a Multidisciplinary Bridge Across the Quality Chasm in Thoracic Oncology (PI: Raymond Osarogiagbon) Improving Advanced Cancer Patient-Centered Care by Enabling Goals of Care Discussions (PI: Nina Bickell) Nueva Vida Intervention: Improving QOL in Latina Breast Cancer Survivors and their Caregivers (PI: Kristi Graves) Collaborative Care to Reduce Depression and Increase Cancer Screening among Low-Income Urban Women (PI: Jonathan Tobin)

Disparities

HDDR Portfolio by Care Continuum

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Prevention n= 14 Screening n= 7 Diagnosis n= 0 Treatment/ Management n= 129 Survivorship n= 3 End of Life/ Palliative Care n= 7

The HDDR funded portfolio addresses multiple phases of the healthcare continuum, ranging from prevention, and various phases of treatment, to survivorship and end of life.

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HDDR Projects Across the Cancer Care Continuum

Prevention Screening Diagnosis Treatment/ Management Survivorship End of Life/ Palliative Care

Prevention

Cultural tailoring of educational materials to minimize disparities in HPV vaccination (PI: Amanda Dempsey)

Screening

Comparing Interventions to Increase Colorectal Cancer Screening in Low-Income and Minority Patients (PI: Susan Rawl)

Diagnosis

**Gap Area in the HDDR Portfolio**

Treatment/ Management

Mobile Application for Improving Symptoms and Adherence to Oral Chemotherapy in Patients with Cancer (PI: Joseph A. Greer)

Survivorship

Evaluation Cancer Survivorship Care Models (PI: Holly Mead)

End of Life/ Palliative Care

Computerized “PAINRelieveIt” Protocol for Cancer Pain Control in Hospice (PI: Robert Molokie)

Success How does this approach work?

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PI: Ron Myers, DSW, PhD Thomas Jefferson University

Increasing CRC Screening among Hispanic Primary Care Patients

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Background

Colorectal cancer (CRC) screening rates are significantly lower in Hispanics than in non- Hispanic whites (47% and 62% respectively). A mailed intervention (a stool blood test kit, instructions for scheduling a screening colonoscopy, and a reminder) is an established way to promote CRC screening. This study tests a new method to maximize CRC screening rates in Hispanic patients.

Increasing CRC Screening among Hispanic Primary Care Patients

PI: Ron Myers Methods

Research Question: This project tested whether telephone-based decision support and navigation can significantly boost CRC screening rates in Hispanic patients. Comparators: A mailed + decision support and navigation intervention arm versus a mailed intervention only arm. Sample: n=400 Hispanic patients age 50-75 years of age, non-adherent to CRC screening Primary outcome: CRC screening adherence within 12 months after recruitment to study.

Findings

At 6 months, the decision support + navigation group showed a higher level of CRC screening adherence compared with the group receiving the mailed intervention only.

Kristi D. Graves, Ph.D.

Nueva Vida Intervention to Improve Quality of Life in Latina Breast Cancer Survivors and their Caregivers

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• Community-Based Organization: Nueva Vida (Washington, DC)
• Successful program to address needs and improve QOL of Latina

Survivors and Caregivers

• Trusted relationship with Latino families
• Academic Partner: Georgetown
• Successful prior research with Latina breast cancer survivors
• Significant interest in intervention research and engaging patients

and families

Evolution of ‘Engaged’ Partnership

Team: Expanded Connections

• Leveraged existing relationships

– Gilda’s Club New York City (NY) – Latinas Contra Cancer (CA) – SHARE (NY, NY)

• Invited internal and external clinicians, patients,

caregivers, researchers and advocates

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Background

Latina breast cancer survivors have lower quality of life outcomes related to physical functioning, social functioning, anxiety, depression, pain, and fatigue, compared to non-Latina survivors. Family members and friends who serve as caregivers are also impacted by the diagnosis but there is limited data on the quality of life for caregivers of Latina survivors.

Methods

Research Question: Does a group psychosocial intervention improve QOL, communication, satisfaction and health outcomes compared to usual care among a diverse group of Latina breast cancer patients and their caregivers? Sample: 100 breast cancer survivor-caregiver dyads; baseline, post-intervention and 6 month follow-up interviews. Outcomes: Quality of life, including global, physical, mental and social health domains.

Improving QOL in Latina Breast Cancer Survivors (PI: Kristi Graves)

• Comparison (randomized controlled trial)
• Nueva Vida Intervention
• Usual Services
• Focus to improve QOL among
• Latina breast cancer survivors
• Caregivers of Latina breast cancer survivors

Study Design: Nueva Vida Intervention

• 8 “talleres” (workshops)
• 2-4 workshops per month
• 5 core topics
• 3 topics: “Research

Democracy”

Study Implementation: “Research Democracy”

Caregiver Group Survivor Group Gather together / Discuss topics

Impact of Cancer on Family (Introduction)* Stress Management* Improving Communication* Spirituality and Cancer* Balancing Physical and Emotional Needs* Anger Management Intimacy after cancer Trauma and Cancer Role Changes Understanding Distress Myths and Cancer Including Others in Helping Caregivers Putting Our Lives in Order

Preliminary Results

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What Happens Next?

D&I Limited Competition PFA

This opportunity gives PCORI awardee teams an opportunity to propose investigator-initiated strategies for disseminating and implementing findings from their PCORI funded studies

Translation

Once peer review is complete, the Dissemination & Implementation Program oversees the translation of these findings into accessible and comprehensible summaries, which are posted on PCORI’s website:

• ne targeting patients and the

general public

• ne for a professional audience

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Thank You Questions & Discussion