Samuel Cykert|Eugenia Eng|Matthew Manning|Linda Robertson|Dwight E. Heron|Nora Jones|Jennifer Schaal|Alexandra F. Lightfoot|Haibo Zhou|Christina Yongue|Ziya Gizlice
A Multi-faceted Intervention Aimed at Black-White Disparities in the Treatment of Early Stage Cancers: The ACCURE Pragmatic Quality Improvement trial
University of North Carolina at Chapel Hill|Cone Health|UPMC Hillman Cancer Center|UPMC Hillman Cancer Center|University of North Carolina at Chapel Hill|University of North Carolina at Greensboro|University of North Carolina at Chapel Hill
reports continue show blacks curable lung breast cancer complete treatment less often similar whites contributing worse survival accure intervention trial designed address problema pragmatic quality improvement trial comparing intervention group retrospective concurrent controls patients early stage breast lung cancer aged 18 85 enrolled n 302 2 cancer centers april 2013 march 2015 intervention component data patients seen january 2007 december 2012 diagnoses obtained establish control completion rates concurrent data nonstudy patients used identify secular trends intervention included real time registry derived electronic health records participants signal missed appointments unmet care milestones navigator clinical feedback primary outcome treatment complete composite variable representing completion surgery recommended radiation chemotherapy patientthe mean age intervention group 631 years 371 patients black treatment completion retrospective concurrent controls showed significant blackwhite differences blacks b 798 vs whites w 873 p 0001 831 b vs 901 w p 0001 respectively disparity lessened within intervention b 884 w 895 p 077 multivariate analyses confirmed disparities reduction blackwhite disparity within intervention 098 95 ci 04621 black completion intervention compared favorably whites retrospective 16 95 ci 09029 concurrent 11 95 ci 05920 controlsa real time registry combined feedback navigation improved completion treatment breast lung cancer patients narrowed disparities similar multifaceted interventions could mitigate disparities treatment cancers chronic conditions