Identifying Core Functions of an Evidence-Based Intervention to Improve Cancer Care Quality in Rural Hospitals.

Autor:	Wahlen MM; Department of Epidemiology, University of Iowa, Iowa City, IA, United States., Schroeder MC; Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, United States., Johnson EC; Department of Management and Entrepreneurship, University of Iowa, Iowa City, IA, United States., Lizarraga IM; Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States., Engelbart JM; Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States., Tatman DJ; Department of Epidemiology, University of Iowa, Iowa City, IA, United States., Wagi C; Department of Implementation Science, Wake Forest University, Winston-Salem, NC, United States., Charlton ME; Department of Epidemiology, University of Iowa, Iowa City, IA, United States., Birken SA; Department of Implementation Science, Wake Forest University, Winston-Salem, NC, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in health services [Front Health Serv] 2022; Vol. 2. Date of Electronic Publication: 2022 Apr 28.
DOI:	10.3389/frhs.2022.891574
Abstrakt:	Background: Rural patients experience worse cancer survival outcomes than urban patients despite similar incidence rates, due in part to significant barriers to accessing quality cancer care. Community hospitals in non-metropolitan/rural areas play a crucial role in providing care to patients who desire and are able to receive care locally. However, rural community hospitals typically face challenges to providing comprehensive care due to lack of resources. The University of Kentucky's Markey Cancer Center Affiliate Network (MCCAN) is an effective complex, multi-level intervention, improving cancer care in rural/under-resourced hospitals by supporting them in achieving American College of Surgeons Commission on Cancer (CoC) standards. With the long-term goal of adapting MCCAN for other rural contexts, we aimed to identify MCCAN's core functions (i.e., the components key to the intervention's effectiveness/implementation) using theory-driven qualitative data research methods. Methods: We conducted eight semi-structured virtual interviews with administrators, coordinators, clinicians, and certified tumor registrars from five MCCAN affiliate hospitals that were not CoC-accredited prior to joining MCCAN. Study team members coded interview transcripts and identified themes related to how MCCAN engaged affiliate sites in improving care quality (intervention functions) and implementing CoC standards (implementation functions) and analyzed themes to identify core functions. We then mapped core functions onto existing theories of change and presented the functions to MCCAN leadership to confirm validity and completeness of the functions. Results: Intervention core functions included: providing expertise and templates for achieving accreditation, establishing a culture of quality-improvement among affiliates, and fostering a shared goal of quality care. Implementation core functions included: fostering a sense of community and partnership, building trust between affiliates and Markey, providing information and resources to increase feasibility and acceptability of meeting CoC standards, and mentoring and empowering administrators and clinicians to champion implementation. Conclusion: The MCCAN intervention presents a more equitable strategy of extending the resources and expertise of large cancer centers to assist smaller community hospitals in achieving evidence-based standards for cancer care. Using rigorous qualitative methods, we distilled this intervention into its core functions, positioning us (and others) to adapt the MCCAN intervention to address cancer disparities in other rural contexts. Competing Interests: Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Databáze:	MEDLINE
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