1
|
Rodriguez SA, Lee SC, Higashi RT, Chen PM, Eary RL, Sadeghi N, Santini N, Balasubramanian BA. Factors influencing implementation of a care coordination intervention for cancer survivors with multiple comorbidities in a safety-net system: an application of the Implementation Research Logic Model. Implement Sci 2023; 18:68. [PMID: 38049844 PMCID: PMC10694894 DOI: 10.1186/s13012-023-01326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Under- and uninsured cancer survivors have significant medical, social, and economic complexity. For these survivors, effective care coordination between oncology and primary care teams is critical for high-quality, comprehensive care. While evidence-based interventions exist to improve coordination between healthcare teams, testing implementation of these interventions for cancer survivors seen in real-world safety-net settings has been limited. This study aimed to (1) identify factors influencing implementation of a multicomponent care coordination intervention (nurse coordinator plus patient registry) focused on cancer survivors with multiple comorbidities in an integrated safety-net system and (2) identify mechanisms through which the factors impacted implementation outcomes. METHODS We conducted semi-structured interviews (patients, providers, and system leaders), structured observations of primary care and oncology operations, and document analysis during intervention implementation between 2016 and 2020. The practice change model (PCM) guided data collection to identify barriers and facilitators of implementation; the PCM, Consolidated Framework for Implementation Research, and Implementation Research Logic Model guided four immersion/crystallization data analysis and synthesis cycles to identify mechanisms and assess outcomes. Implementation outcomes included appropriateness, acceptability, adoption, and penetration. RESULTS The intervention was appropriate and acceptable to primary care and oncology teams based on reported patient needs and resources and the strength of the evidence supporting intervention components. Active and sustained partnership with system leaders facilitated these outcomes. There was limited adoption and penetration early in implementation because the study was narrowly focused on just breast and colorectal cancer patients. This created barriers to real-world practice where patients with all cancer types receive care. Over time, flexibility intentionally designed into intervention implementation facilitated adoption and penetration. Regular feedback from system partners and rapid cycles of implementation and evaluation led to real-time adaptations increasing adoption and penetration. DISCUSSION Evidence-based interventions to coordinate care for underserved cancer survivors across oncology and primary care teams can be implemented successfully when system leaders are actively engaged and with flexibility in implementation embedded intentionally to continuously facilitate adoption and penetration across the health system.
Collapse
Affiliation(s)
- Serena A Rodriguez
- Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), 2777 North Stemmons Freeway, Dallas, TX, 75207, USA.
- Center for Health Promotion & Prevention Research, UTHealth Houston School of Public Health, 7000 Fannin, Houston, TX, 77030, USA.
- UTHealth Houston Institute for Implementation Science, 2777 North Stemmons Freeway, Dallas, TX, 75207, USA.
| | - Simon Craddock Lee
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
- University of Kansas Cancer Center, 2650 Shawnee Mission Parkway, Westwood, KS, 66205, USA
| | - Robin T Higashi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Patricia M Chen
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd., Suite 303, Dallas, TX, 75390, USA
| | - Navid Sadeghi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 6202 Harry Hines Blvd, Dallas, TX, 75235, USA
- Parkland Health, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA
| | - Noel Santini
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Parkland Health, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA
| | - Bijal A Balasubramanian
- Center for Health Promotion & Prevention Research, UTHealth Houston School of Public Health, 7000 Fannin, Houston, TX, 77030, USA
- UTHealth Houston Institute for Implementation Science, 2777 North Stemmons Freeway, Dallas, TX, 75207, USA
- Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth Houston School of Public Health, 2777 North Stemmons Freeway, Dallas, TX, 75207, USA
| |
Collapse
|