Across the spectrum of cancer types, outcomes research has demonstrated that the quality of cancer care varies in the United States (US). Understanding this variation and, more importantly, how to correct it is the future direction for cancer health services research. This proposal seeks to understand and address the barriers to evidence-based cancer care while providing the career development candidate with a very rich research training and mentorship experience. The research proposal focuses specifically on the quality of surgical care for rectal cancer, which is diagnosed in more than 40,000 Americans each year. There is strong evidence linking the use of evidence-based surgical practices with improved outcomes for this disease. However, variation in the use of evidence-based practices and treatment outcomes for rectal cancer has been demonstrated, suggesting opportunities to improve the quality of care. The proposal's research aims include (1) assessing hospitals'compliance with evidence-based practices for rectal cancer, within the setting of an existing surgical quality-improvement organization;(2) qualitatively assessing barriers to uptake of evidence- based practices;and (3) designing and evaluating an intervention to increase use of evidence-based practices. This project, the multidisciplinary mentorship team, and the research environment are ideally suited to address the career goals and educational needs of the candidate, Samantha Hendren, MD, MPH. Dr. Hendren is a board-certified colorectal surgeon with a clinical and research interest in colorectal neoplasms. Her prior research experience with measuring cancer outcomes and interventions to optimize cancer care has prepared her for this proposal. However, to achieve her career goal of improving colorectal cancer care through hospital-based quality-improvement programs, she will need additional training. Educational goals, including obtaining expertise in implementation science, advanced statistical methods for comparing hospital performance, and organization of collaborative programs, are feasible with the grant's educational plan and highly accomplished mentorship team. The educational program includes graduate-level courses in qualitative methods, hierarchical modeling, and health communications, as well as travel to centers of excellence and relevant national conferences. In summary, this research project, mentor team, and educational plan will lay the groundwork for Dr. Hendren to perform ongoing, innovative, independent research to improve colorectal cancer treatment and outcomes.

Public Health Relevance

This proposal will measure variation in evidence-based practices for rectal cancer care, provide understanding of barriers to evidence-based practice via qualitative study of cancer surgeons, and implement an intervention to improve uptake of evidence-based practices through an existing healthcare quality organization. These results will have immediate impact on the understanding of best strategies for increasing implementation of evidence to decrease unwanted variation in cancer care.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Academic/Teacher Award (ATA) (K07)
Project #
5K07CA163665-02
Application #
8544434
Study Section
Subcommittee G - Education (NCI)
Program Officer
Perkins, Susan N
Project Start
2012-09-12
Project End
2017-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
2
Fiscal Year
2013
Total Cost
$174,960
Indirect Cost
$12,960
Name
University of Michigan Ann Arbor
Department
Surgery
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Abdelsattar, Zaid M; Reames, Bradley N; Regenbogen, Scott E et al. (2015) Critical evaluation of the scientific content in clinical practice guidelines. Cancer 121:783-9
Hendren, Samantha; Winters, Paul; Humiston, Sharon et al. (2014) Randomized, controlled trial of a multimodal intervention to improve cancer screening rates in a safety-net primary care practice. J Gen Intern Med 29:41-9
Fortuna, Robert J; Idris, Amna; Winters, Paul et al. (2014) Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening. J Gen Intern Med 29:90-7
Schootman, M; Lian, M; Pruitt, S L et al. (2014) Hospital and geographic variability in two colorectal cancer surgery outcomes: complications and mortality after complications. Ann Surg Oncol 21:2659-66
Schootman, Mario; Lian, Min; Pruitt, Sandi L et al. (2014) Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery. Health Serv Res 49:1145-64
Hendren, Samantha; Fiscella, Kevin (2014) Patient navigation improves the care experience for patients with newly diagnosed cancer. J Clin Oncol 32:3-4
Abdelsattar, Zaid M; Wong, Sandra L; Birkmeyer, Nancy J et al. (2014) Multi-institutional assessment of sphincter preservation for rectal cancer. Ann Surg Oncol 21:4075-80
Sheetz, Kyle H; Waits, Seth A; Krell, Robert W et al. (2014) Complication rates of ostomy surgery are high and vary significantly between hospitals. Dis Colon Rectum 57:632-7
Hendren, Samantha; McKeown, Ellen; Morris, Arden M et al. (2014) Implementation of a hospital-based quality assessment program for rectal cancer. J Oncol Pract 10:e120-9
Abdelsattar, Zaid M; Krell, Robert W; Campbell Jr, Darrell A et al. (2014) Differences in hospital performance for noncancer vs cancer colorectal surgery. J Am Coll Surg 219:450-9

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