The transfer and application of scientific evidence into everyday practice is necessary to mitigate health disparities, yet roadblocks persist in broad implementation of evidence-based interventions among vulnerable communities experiencing disparities. The Boston Breast Cancer Equity Coalition was formed in 2014 in response to persistent city-wide disparities in breast cancer mortality among minority, low-income women. The Coalition identified three evidence-based strategies known to reduce delays in care that have yet to be deployed into clinical practice, due to a lack of implementation strategies (T3-T4 implementation translation). Translating Research into Practice (TRIP) draws upon the principles of community-engaged dissemination and implementation science to systematically facilitate deployment and utilization of: (a) regional patient registries; (b) systematic screening for social barriers to care with a personalized referral plan; and (c) patient navigation services into one integrated model of care to improve the quality and effectiveness of care delivery, in this case for minority and/or low-income women with breast cancer. The four Massachusetts CTSA hubs (Boston University, Harvard University, Tufts University, and University of Massachusetts) partnered with the Boston Breast Cancer Equity Coalition to overcome barriers to widespread implementation and dissemination of evidence based practices that will improve the delivery of guideline-concordant care to vulnerable women. The study will be conducted in three phases: First, we will deploy regional CTSA expertise to support the local healthcare community to develop the three individual TRIP components, create the study data repository, and refine and integrate the intervention components into a cohesive package that can be implemented within the context of the clinical work flow of the partnering sites. Then, we will conduct a type 1 hybrid effectiveness- implementation study among 1,100 vulnerable breast cancer patients seeking care across six health systems in Boston. We will evaluate the healthcare system?s ability to implement these three generalizable tools (fidelity to intervention protocol, costs, local adoption/sustainability, and acceptability) into an integrated intervention and the impact on clinical outcomes (time to first treatment and receipt of guideline concordant cancer care). Finally, we will promote widespread dissemination to other CTSA hubs, health systems, and community- academic partnerships. Our main hypothesis is that widespread implementation of these tools will eliminate care delivery disparities, and CTSA hubs have the translational expertise to overcome barriers to such implementation.
The Boston Breast Cancer Equity Coalition has found that in Boston, Massachusetts, as in most US cities, inequities in breast cancer mortality continue to increase among minority, low-income women as a result of persistent gaps in the delivery of evidence-based care into routine cancer care for all women. Translating Research into Practice (TRIP) draws upon the principles of community-engaged dissemination and implementation science to understand how to systematically facilitate deployment and utilization of three evidence-based approaches (regional patient registries, systematic screening for social barriers to care, and patient navigation services) into one integrated model of care to improve the quality and effectiveness of care delivery, in this case for minority and/or low-income women with breast cancer.
