Miria Kano

MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients—a randomized cluster trial

BackgroundEvidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement.Methods/designWe are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness.DiscussionThis study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians.Trial registrationClinicalTrials.gov: NCT02138448

Costs and inconsistencies in US IRB review of low-risk medical education research.

Advances in communication technologies over the last two decades have transformed the way medical education research is conducted, creating opportunities for multi‐institution national and international studies. Although these studies enable researchers to gain broader understandings of educational processes across institutions, they increase the need for multiple institutional review board (IRB) reviews to ensure the protection of human subjects.

Practice-based Research Network Research Good Practices (PRGPs): Summary of Recommendations

Practice‐based research networks (PBRNs) conduct research in community settings, which poses quality control challenges to the integrity of research, such as study implementation and data collection. A foundation for improving research processes within PBRNs is needed to ensure research integrity.

Team Science Approach to Developing Consensus on Research Good Practices for Practice-Based Research Networks: A Case Study.

Using peer learning strategies, seven experienced PBRNs working in collaborative teams articulated procedures for PBRN Research Good Practices (PRGPs). The PRGPs is a PBRN‐specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. This paper describes the team science processes which culminated in the PRGPs. Skilled facilitators used team science strategies and methods from the Technology of Participation (ToP®), and the Consensus Workshop Method to support teams to codify diverse research expertise in practice‐based research. The participatory nature of “sense‐making” moved through identifiable stages. Lessons learned include (1) team input into the scope of the final outcome proved vital to project relevance; (2) PBRNs with diverse domains of research expertise contributed broad knowledge on each topic; and (3) ToP® structured facilitation techniques were critical for establishing trust and clarifying the “sense‐making” process.

Racial/Gender Biases in Student Clinical Decision-Making: a Mixed-Method Study of Medical School Attributes Associated with Lower Incidence of Biases

BackgroundAccumulating evidence suggests that clinician racial/gender decision-making biases in some instances contribute to health disparities. Previous work has produced evidence of such biases in medical students.ObjectiveTo identify contextual attributes in medical schools associated on average with low levels of racial/gender clinical decision-making biases.DesignA mixed-method design using comparison case studies of 15 medical schools selected based on results of a previous survey of student decision-making bias: 7 schools whose students collectively had, and 8 schools whose students had not shown evidence of such biases.ParticipantsPurposively sampled faculty, staff, underrepresented minority medical students, and clinical-level medical students at each school.Main MeasuresQuantitative descriptive data and qualitative interview and focus group data assessing 32 school attributes theorized in the literature to be associated with formation of decision-making and biases. We used a mixed-method analytic design with standard qualitative analysis and fuzzy set qualitative comparative analysis.Key ResultsAcross the 15 schools, a total of 104 faculty, administrators and staff and 21 students participated in individual interviews, and 196 students participated in 29 focus groups. While no single attribute or group of attributes distinguished the two clusters of schools, analysis showed some contextual attributes were seen more commonly in schools whose students had not demonstrated biases: longitudinal reflective small group sessions; non-accusatory approach to training in diversity; longitudinal, integrated diversity curriculum; admissions priorities and action steps toward a diverse student body; and school service orientation to the community.ConclusionsWe identified several potentially modifiable elements of the training environment that are more common in schools whose students do not show evidence of racial and gender biases.

Effective Strategies for Affordable Care Act Enrollment in Immigrant-Serving Safety Net Clinics in New Mexico

In the new Affordable Care Act (ACA) health care environment, safety-net institutions continue to serve as important sources of culturally appropriate care for different groups of immigrant patients. This article reports on a qualitative study examining the early ACA enrollment experiences of a range of health care providers (n = 29) in six immigrant-serving safety-net clinics in New Mexico. The six clinics configured their ACA enrollment strategies differently with regard to operations, staffing, and outreach. Providers reported a generally chaotic rollout overall and expressed frustration with strategies that did not accommodate patients, provided little training for providers, and engaged in minimal outreach. Conversely, providers lauded strategies that flexibly met patient needs, leveraged trust through strategic use of staff, and prioritized outreach. Findings underscore the importance of using and funding concerted strategies for future enrollment of immigrant patients, such as featuring community health workers and leveraging trust for outreach.

Optimizing endometrial cancer follow-up and survivorship care for rural and other underserved women: Patient and provider perspectives

OBJECTIVES This study describes patient and provider attitudes on transitioning cancer surveillance visits and treatment of comorbid conditions to the primary care setting in a rural patient population as a strategy for minimizing financial and travel related barriers for patients while simultaneously enhancing quality and availability of health care options. METHODS Focus group discussions and telephone interviews were conducted with endometrial cancer (EC) survivors and primary care providers (PCPs) to provide insights into post-treatment follow-up practices and the acceptability of transitioning follow-up to primary care setting utilizing a cancer survivorship care plan model. RESULTS EC survivors expressed high levels of satisfaction with their oncology care and suggested that transitioning to PCPs for follow-up care would be convenient yet challenging. Challenges cited include: 1) patient perceptions of deficits in PCPs understandings of cancer surveillance; 2) inability to identify a personal PCP; and 3) lack of communication between oncologists and PCPs. PCP participants similarly identified the need for extensive EC training and effective communication strategies with oncologists as necessary factors for accepting responsibility for EC follow-up care. Both groups offered strategies to create a more team based approach to EC survivorship care. CONCLUSIONS Increasing the role of the PCP in the ongoing care of EC survivors was generally considered acceptable by both patients and providers in both rural and urban women. Successful coordination of care between cancer survivors, oncologists and PCPs will be a critical step in improving the cancer care delivery of our rural patient and provider population.

Abstract C50: Geographic Management of Cancer Health Disparities Program (GMaP): A regional strategy for expanding the Continuing Umbrella of Research Experiences (CURE) pipeline in cancer research nationwide

Background/Rationale: The Geographic Management of Cancer Health Disparities Program (GMaP), initiated in 2009, is a national program funded by the National Cancer Institute9s Center to Reduce Cancer Health Disparities (CRCHD). CRCHD is committed to funding training for those from backgrounds under-represented in cancer biomedical and behavioral sciences research. Based on the belief that a diverse workforce is essential for advancing cancer research and reducing cancer health disparities (CHD), CRCHD developed innovative and comprehensive research training programs. GMaP, consisting of seven regions across the nation, strives to support these programs and enhance capacity in areas of: • CHD research • Recruitment and professional development of under-represented investigators, trainees, and students • Communication and dissemination of NCI priorities, cancer/CHD trainings, and professional development opportunities • Strengthening region-based community education and engagement through partnerships with university cancer centers, minority-serving institutions and Community Health Education Programs We highlight strategies utilized across GMaP regions to increase recruitment and retention of diverse investigators; expand the Continuing Umbrella of Research Experiences (CURE) Pipeline; cultivate professional development for students and early-stage investigators; promote innovative, cooperative research to reduce CHD; increase participation of minority populations under-represented in extant cancer research agendas; and encourage health equity for diverse U.S. cancer patient and survivor populations. Approach: Though each region operates independently, many strategies have been identified as best practices for raising awareness of CHD, the GMaP network, and the diversity training programs it supports, as well as NCI/CRCHD funding priorities. Utilizing a core administrative structure, Regional Coordinating Director(s) provide clear communication via websites, listservs, e-blasts, and other social media. GMaP regions offer several resources to students/investigators working in cancer or CHD research, including: • Pilot project and/or research completion awards—1-year grants between

Abstract B20: Optimizing endometrial cancer follow-up and survivorship care for rural and other underserved women: Patient and provider perspectives

5000 and

Abstract B24: Health related quality of life during cancer treatment: Perspectives of adolescent and young adult cancer patients and caregivers

20,000 for early-stage investigators to develop data or complete pilot research for use towards larger grant submissions • Travel scholarships–to facilitate conference, workshop, or mentor meeting travel • Annual meetings/workshops—face to face experiences to improve grant-development skills, meet potential mentors, develop cross-institutional collaborations, and discuss research priorities and projects in the region • Expert grant review–grant application (e.g., K-awards) reviews by senior researchers to improve scientific merit of grant applications by junior investigators • Research Day events—opportunities to highlight junior investigators • Educational webinar series–on-line training on grant development and various CURE grant mechanisms • Undergraduate pipeline programs–to promote research experiences for underrepresented minority students interested in cancer research Results: We will share specific examples of these successful strategies utilized to engage more than 3,290 cancer/CHD researchers, faculty, and students across the U.S., including distribution of nearly 4,000 training, funding, and career opportunities. We will discuss outcomes such as successful receipt of CURE funding and increased numbers of diverse applicants in the cancer/cancer health disparities pipelines to demonstrate the effectiveness of such coordinated efforts. Conclusion: Utilizing a national network with regional programming is an efficient and effective way to increase recruitment and retention of diverse investigators in NCI research and community programs. This poster/presentation substantiates the need for continued efforts to recruit and support diverse cancer/CHD scholars from student levels to senior investigators. Citation Format: Carrie M. Norbeck, Miria Kano, Kimberly R. Williams. Geographic Management of Cancer Health Disparities Program (GMaP): A regional strategy for expanding the Continuing Umbrella of Research Experiences (CURE) pipeline in cancer research nationwide [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C50.