Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
BMJ Open. 2022 Dec 13;12(12):e067439. doi: 10.1136/bmjopen-2022-067439.
Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador.
This research is two pronged: (A) quasi-experimental design (controlled before and after) with an intervention and a control healthcare network in each LA country, using an implementation-effectiveness hybrid approach to assess the intervention process, effectiveness and costs; and (B) case study design to analyse access to diagnosis of most frequent cancers. Focusing on the most vulnerable socioeconomic population, it develops in four phases: (1) analysis of delays and barriers to early diagnosis (baseline); (2) intervention adaptation and implementation (primary care training, fast-track referral pathway and patient information); (3) intracountry evaluation of intervention and (4) cross-country analysis. Baseline and evaluation studies adopt mixed-methods qualitative (semistructured individual interviews) and quantitative (patient questionnaire survey) methods. For the latter, a sample size of 174 patients with cancer diagnosis per healthcare network and year was calculated to detect a proportions difference of 15%, before and after intervention (α=0.05; β=0.2) in a two-sided test. A participatory approach will be used to tailor the intervention to each context, led by a local steering committee (professionals, managers, policy makers, patients and researchers).
This study complies with international and national legal stipulations on ethics. It was approved by each country's ethical committee and informed consent will be obtained from participants. Besides the coproduction of knowledge with key stakeholders, it will be disseminated through strategies such as policy briefs, workshops, e-tools and scientific papers.
医疗保健碎片化是导致拉丁美洲（LA）癌症诊断和治疗延误的主要原因，这导致该地区的死亡率很高，尤其是在弱势群体中。本研究聚焦于综合护理干预，该干预在该地区的实施受到限制。本研究的目的是评估在智利、哥伦比亚和厄瓜多尔的医疗保健网络中扩大综合护理干预以改善常见癌症早期诊断的实施效果。
本研究有两个方面：（A）在每个 LA 国家的干预和对照医疗保健网络中采用准实验设计（对照前后），使用实施效果混合方法评估干预过程、效果和成本；（B）通过案例研究设计分析最常见癌症的诊断途径。该研究重点关注最弱势的社会经济人群，分四个阶段进行：（1）分析早期诊断的延迟和障碍（基线）；（2）干预调整和实施（基层医疗培训、快速转诊途径和患者信息）；（3）国家内部评估干预；（4）国家间分析。基线和评估研究采用混合方法定性（半结构化个体访谈）和定量（患者问卷调查）方法。对于后者，计算了每个医疗保健网络和年份的 174 例癌症诊断患者的样本量，以检测干预前后 15%的比例差异（α=0.05；β=0.2），采用双侧检验。将采用参与式方法根据当地情况调整干预措施，由当地指导委员会（专业人员、管理人员、政策制定者、患者和研究人员）领导。
本研究符合国际和国家有关伦理的法律规定。每个国家的伦理委员会都批准了该研究，并将获得参与者的知情同意。除了与主要利益相关者共同生产知识外，还将通过政策简报、研讨会、电子工具和科学论文等策略进行传播。
