School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA.
School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA.
J Cancer Surviv. 2024 Dec;18(6):2022-2032. doi: 10.1007/s11764-023-01440-y. Epub 2023 Aug 6.
To describe policy and system-level interventions with potential to improve cancer care at six sites.
In 2016, six institutions received foundation support to develop unique multi-component interventions aimed at improving cancer care for underserved populations. These organizations, located across the United States, participated in a cross-site evaluation to assess the overall initiative impact and to identify potentially promising policy and system-level solutions for dissemination and broader implementation. A health system and policy tracking tool was developed to collect data from each site and included a description of their efforts, strategies employed, and changes achieved (e.g., new policies, clinical protocols). Tracking tool data were analyzed using rapid qualitative analyses and a matrix approach. Semi-structured interviews were conducted with site leaders (N = 65) and were analyzed by thematic analysis.
Sites reported 20 system and policy efforts, which resulted in improvements to electronic health records and telehealth strategies, changes to hospital/health system policies, and standardized clinical protocols/guidelines, among others. Efforts were aimed at: (1) coordinating care across multiple providers, supported by patient navigators; (2) expanding psychosocial and supportive care; (3) improving patient-provider communication; and (4) addressing barriers to accessing care. Interview analyses provided insights into successful strategies, challenges, and implications of the COVID-19 pandemic on cancer care.
Despite advances in diagnosis and treatment, cancer care remains inequitable. System-level improvements aimed at eliminating common barriers faced by underserved populations offer opportunities to improve the delivery of equitable, effective, and efficient care.
描述有潜力改善六个地点癌症护理的政策和制度层面干预措施。
2016 年，六个机构获得基金会的支持，以制定独特的多组成分干预措施，旨在改善服务不足人群的癌症护理。这些组织分布在美国各地，参与了跨站点评估，以评估整体计划的影响，并确定具有潜在推广价值的政策和制度层面解决方案，以进行更广泛的实施。开发了一种卫生系统和政策跟踪工具，从每个站点收集数据，其中包括对其努力、采用的策略和实现的变革（例如新政策、临床方案）的描述。使用快速定性分析和矩阵方法对跟踪工具数据进行了分析。对站点负责人（N=65）进行了半结构化访谈，并进行了主题分析。
各站点报告了 20 项制度和政策举措，这些举措改进了电子健康记录和远程医疗策略，改变了医院/卫生系统的政策，并制定了标准化的临床方案/指南等。这些努力旨在：（1）通过患者导航员协调多个提供者的护理；（2）扩大心理社会和支持性护理；（3）改善医患沟通；以及（4）解决获得护理的障碍。访谈分析提供了对成功策略、挑战以及 COVID-19 大流行对癌症护理影响的见解。
尽管在诊断和治疗方面取得了进展，但癌症护理仍然存在不平等现象。旨在消除服务不足人群面临的常见障碍的制度层面改进为改善公平、有效和高效的护理提供了机会。
