African American cancer patients, as compared to White counterparts, continue to initiate treatment later and remain less apt to undergo complete treatment; fueling worse treatment outcomes including shorter survival. Persistent inequities experienced by African American cancer patients while in treatment demand a diligent and bold response. Yet, few prospective studies have identified systemic causes for less than optimal cancer care for African Americans and even fewer show effective interventions. ACCURE proposes to accomplish both of these goals through an intervention that will optimize transparency and system accountability for racial equity in the completion of treatment for early stage breast and lung cancer.
Topic area(s): Health Disparities
The Greensboro Health Disparities Collaborative and two Cancer Centers have joined together to investigate how the healthcare institution can be enhanced to reduce racial inequity in quality and completion of treatment for Stage 1-2 breast and lung cancer patients. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) is a systems enhancement intervention.
Methods: ACCURE has components, hypothesized to reduce racial inequities in completing treatment of early stage breast and lung cancer. A specially trained ACCURE Navigator to will provide a 2-way communication for hearing and responding to patients at both Cancer Centers, with the enhanced use of an Electronic Medical Record Technology Tool (the “Real-time Registry”), and evidence-based patient education and follow-up protocols. Other components are (1) the Healthcare Equity Training + booster sessions for providers on the contributing factors of racial inequities; and (2) Monthly Clinical Performance Reports delivered by a Physician Champion to clinicians and their teams on race-specific, quality of care data for their patients + suggestions for improving care. To assess the separate and combined effects, in real time, from the intervention on completion of treatment, we propose a 5-year interrupted time series, with an embedded, 3-year randomized control trial, study design.
Potential Impact of findings are to: help define “meaningful use” requirements for health IT, established by national policy-making bodies; contribute to the American College of Surgeons Rapid Quality Reporting System; and, ultimately, create sustainable change to quality care within the health system. Our systems approach has the potential to optimize transparency of and accountability for racial equity in completing treatment in 1500 cancer centers affecting 1.4 million cancer patients annually.
Christina Yongue Hardy, MPH, Project Manager