Investigators at Boston University Clinical and Translational Science Institute (BU-CTSI) and colleagues have been awarded a five-year, $8.6 million grant from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS) to develop, test, and disseminate a replicable, high-quality coordination of care approach for vulnerable populations experiencing disparities.
Called TRIP (Translating Research Into Practice), it will focus on African American women with breast cancer and the disparities they face in in time-to-treatment, quality of treatment and delayed follow up to abnormal tests.
In addition to BU-CTSI, investigators include Tufts CTSI, Brigham and Women’s Hospital and Harvard Catalyst (the Harvard Clinical and Translational Science Center), and University of Massachusetts Center for Clinical and Translational Science (CCTS).
“This is an important approach to implementing clinical care. Models that work in one institution with selected patient populations must be tested at other institutions to ensure that best practices can be transferred. This program will begin to tell us how to approach diagnosis of breast cancer in women from many different socio-economic and ethnic backgrounds, said David Center, MD, Director of the BU-CTSI. “This is a perfect use of the NCATS Cooperative CTSA Innovation Award network, which funds unique ideas from individual CTSIs that propose to use the resources of multiple CTSA institutions.”
In partnership with the Boston Breast Cancer Equity Coalition, a diverse group of local community stakeholders whose mission is to achieve equity for all women with breast cancer, TRIP researchers found that three evidence-based strategies known to reduce delays in care have failed to make it into practice as a result of persistent patient and health system barriers:
- A navigator for every vulnerable patient to solve problems and provide support and guidance through the complex health care system;
- A regional registry to help providers and navigators track their patients; and
- Resources to help navigators identify social determinants of health (e.g., food and housing insecurity).
TRIP will integrate these strategies into a cohesive package across six hospitals, with the goal of assisting 1,100 women seeking breast cancer care over the next five years. A key aspect of the project is to test the effectiveness of the combined approach.If successful, TRIP can be adapted to the treatment of any disease in other communities impacted by health disparities.
TRIP will be led by principal investigators Tracy Battaglia, MD, MPH of BU-CTSI; Karen Freund, MD, MPH of Tufts CTSI; Jennifer Haas, MD, MPH of Brigham and Women’s Hospital and Harvard Catalyst; and Stephenie Lemon, PhD of UMass CCTS. The six participating clinical sites are Boston Medical Center, Brigham & Women’s Faulkner Hospital, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, Massachusetts General Hospital, and Tufts Medical Center. Boston Breast Cancer Equity Coalition, Boston Patient Navigator Network, the University of Chicago, and the Institute for Translational Medicine will build a coalition of stakeholders and provide community engagement support.
“The rapid rate of scientific discovery far outpaces the ability of our health care system to integrate evidence into every day practice, especially in cancer care for low income, racial ethnic minority patients who remain less likely to receive timely, quality treatment,” said Battaglia, who also is a BMC internal medicine physician. ”Sustainable solutions require collaboration among all community stakeholders, including patients, providers, public health practitioners, health systems and scientific investigators. Community engaged research conducted in real life settings is necessary to ensure scientific discoveries reach all populations.”
TRIP is in its start-up phase, consisting of stakeholder interviews, implementation planning, and development of the registry and screening tools. Then the academic, clinical and community partners will have four years to implement and test TRIP across the six participating hospitals.
Once completed, this community engaged program will demonstrate the feasibility of community-academic partnerships to provide innovations in information-sharing and systems implementation that will translate into reductions in health disparities for vulnerable patients facing any disease.
“This innovative model of care links multiple clinical systems and community resources to meet the many needs of women with breast cancer in Boston,” said Lemon, professor of medicine in the Division of Preventive and Behavioral Medicine at University of Massachusetts Medical School and co-director of community engagement at the UMass CCTS. “However, people with different conditions and in different locations experience similar struggles. If we find this model to be effective, it has potential to transform collaborative care delivery for other disease conditions and in places across the country. We have the goal of scaling up the care delivery model once we have completed the initial project in Boston. We have engaged partners from Chicago to be the first to work with us to identify ways to spread our model.”
TRIP is supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number U01TR002070, and by the NIH Office of Behavioral and Social Sciences Research The content of this release is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.