Studying the implementation of evidence-based interventions ...Studying the implementation of...
Transcript of Studying the implementation of evidence-based interventions ...Studying the implementation of...
Studying the implementation of evidence-based interventions for
cancer prevention
Prajakta Adsul, MBBS, MPH, PhD
Assistant Professor, Department of Internal MedicineUniversity of New Mexico School of Medicine and
Comprehensive Cancer Center
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No disclosures to report
Outline
• Professional background
• What is implementation science?
• Ongoing collaborations with federal/national networks• CCCNP• CPCRN
• What is happening in New Mexico?• CRC moonshot• CHW toolkit• Cancer control plans
• How has COVID affected cancer screening?
• Future directions
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Professional Background
Clinical medicine
Public health
Cancer prevention
Implementation research
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Evidence-based interventions for cancer prevention
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Evidence base for screeningUnited States Preventive Services Task Force
Breast Cancer (2016)
Grade B 50-74 years Mammography Every 2 years
Colorectal cancer(2016)
Grade A 50-75 years Multiple tests Varies with test
Cervical cancer(2018)
Grade A 21-29 years Pap smears Every 3 years
30-65 yearsCo-testing or
hrHPV DNA as primary
Every 5 years
https://www.uspreventiveservicestaskforce.org/Page/Name/recommendations |6
Screening is a series of steps and can be influenced by factors at multiple socio-ecological levels
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Cancer Control Continuum
https://cancercontrol.cancer.gov/od/continuum.html|8
Multiple levels of influence on cancer care
Taplin, S. et al. 2012 |9
Complexity in studying implementation of screening
Uptake is dependent on behavior and delivery of services
Clinical and community settings
Multiple stakeholders
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Implementation research methods to study cancer screening
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Implementation research
“scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical and community settings in order to improve patient outcomes and benefit population health”
NIH PAR -19 - 274|12
Implementation Research Methods
What?
Evidence Based
Interventions
How?
ImplementationStrategies
ServiceOutcomes*
EfficiencySafety
EffectivenessEquity
Patient-centeredness
Timeliness
Health Outcomes
SatisfactionFunction
Health status/symptoms
Implementation Outcomes
AcceptabilityAdoption
AppropriatenessCosts
FeasibilityFidelity
PenetrationSustainability
Proctor, E.K., 2009|13
Cancer screening implementation – collaborations with national networks 1. Comprehensive Cancer Control National Partnership (https://cccnationalpartners.org) 2. Cancer Prevention and Control Research Network (https://cpcrn.org/)
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Comprehensive Cancer Control National Partnership
Technical assistance as an implementation strategy for uptake of evidence-based interventions CRC Screening - 2015 - 11 state teams
HPV Vaccination – 2016 - 11 state teams
Expert presentations – brainstorming per local context – action planning
Total participants ~120 (including experts)
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Centralizing technical assistance
Evaluation using a survey showed: Improved knowledge and attitudes towards
use evidence-based interventions
Increased number of evidence-based interventions on the state action plans
Increased collaborations among state team members and across teams
Increased state level partnerships
Qualitative interviews
Mooreland-Russell, S., Adsul, P. et. al. ., 2019; Adsul, P., Chambers, D., 2019 |16
11 state teams that received HPV vaccination related technical assistance
11 state teams that received CRC screening related technical assistance
Cancer Prevention and Control Research Network (CPCRN)
National network of academic, public health, and community partners who work together to reduce the burden of cancer, especially among those disproportionately affected
Community-based participatory cancer research across its eight network centers, crossing academic affiliations and geographic boundaries.
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RURAL focus
Health Organizations
Cancer screening implementation – local collaborations1. Colorectal Cancer Screening Programs across American Indian communities (More information here:
https://www.cancer.gov/research/key-initiatives/moonshot-cancer-initiative/implementation/prevention-early-detection )
2. NCI funded CRC Screening Toolkit developed in NM3. Review of Cancer Control State Plans for colorectal cancer screening
(https://www.cdc.gov/cancer/ncccp/ccc_plans.htm)
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Cancer Moonshot – CRC in American Indian Communities
PI – Dr. Shiraz Mishra/ Dr Kevin English in collaboration with Albuquerque Area Indian Health Board
Rationale: AI/ANs are significantly less likely than non-Hispanic Whites to receive timely and risk- and age-appropriate cancer screenings, including recommended CRC screening. The short term goal is to enhance annual CRC screening using the fecal immunochemical test (FIT) using collaborative approaches with healthcare provider teams
Working with Santo Domingo and Jemez Pueblo
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Saving Lives - Increasing CRC screening in NM Hispanics
Finalized the toolkit and training through a multi-year process that incorporated community and stakeholder input (available upon request)
Educating CHWs and providing them with appropriate materials addresses some gaps to improve CRC screening rates; however, other barriers to screening among NM Hispanics remain
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Reviewing 4 corners state cancer control plans for CRC
How do they approach local data and statistics?
What are some of the evidence-based approaches that are being used?
How are they implementing these interventions, given some of the contextual barriers?
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COVID and Cancer Screening
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Impact of COVID
Electronic Medical Records at 39 health systems representing 190 hospitals in 23 states
Compared to 2017-2020 January, March 2020 the screening rate decreased by 86-94%
23https://ehrn.org/wp-content/uploads/Preventive-Cancer-Screenings-during-COVID-19-Pandemic.pdf |23
Role of telehealth, health equity concerns, etc.
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Seeing an increase in telehealth, but concerns about sustainability
Changing an approach to incorporate health equity, at times these are at crossroads
Rising COVID cases
Some guidance from national organizations like CCCNP -- https://drive.google.com/file/d/1gw4OBTUEa0W6_KEcLub5va6dr-
Re1Fuh/view
Recent guidance from National Colorectal Cancer Round Table (NCCRT)
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Silver linings?
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Prior to COVID, CRC screening rate in NM was at 49% in FQHCs and BRFSS shows 65% met USPSTF recommendations
April 2020 survey of NM FQHCs showed 50% of visits were virtual
Evidence on home-based cancer screening tests
Future directions
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CRC white paper
State cancer control plans review for CRC
Promoting home based tests for both cervical and colorectal cancer screening in FQHCs
Questions?
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@PrajaktaAdsul