PO.SHP01.02 · 科学与健康政策
CoMMunity 项目：部署本地学习网络以应对两个社区中多发性骨髓瘤诊疗缺口
Project CoMMunity: A local learning network deployed to address multiple myeloma care gaps in two communities
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言 多发性骨髓瘤（MM）的治疗进展带来了五年生存率的改善。然而，在标准诊疗（SOC）和新疗法的可及性与采用方面仍存在缺口。因此，诊疗差异持续存在。CoMMunity 项目是一个多中心、本地学习网络，旨在发现未满足的需求，理解影响 SOC 治疗可及性的障碍，并通过创新的肿瘤学合作和有针对性的干预来应对诊疗缺口。
材料/方法 采用多方法途径，在纽约州纽约市和北卡罗来纳州温斯顿-塞勒姆的学术和社区肿瘤诊疗机构之间实施整合的本地学习网络。通过与多元利益相关方的社区圆桌会议开展需求评估和共创会议，以识别障碍和解决方案。对各社区 MM 患者的电子病历数据进行了比较。通过一对一访谈征询临床医生报告的限制 SOC 治疗可及性和依从性的障碍及根本原因。
结果 在参加圆桌会议的 12 名临床医生和 4 名社会工作者/患者倡导者中，常见障碍包括健康素养/社会经济因素、社区与学术临床关系有限、文化/种族问题和患者信任度低、复杂的患者优先事项/医疗状况，以及临床试验接触有限。利益相关方指出了支持教育和意识、改善社区与学术机构之间诊疗连续性过渡以及开发教育材料的机会。在 332 例患者中（纽约 237 例；北卡 95 例），定量分析凸显了从诊断到专科就诊时间（纽约：34 天 vs 北卡：62 天）、一线治疗（1LOT）方案（四联方案，纽约：62.3% vs 北卡：11.6%；三联方案，纽约：34.3% vs 北卡：79.0%）以及干细胞移植发生率（纽约：30.8% vs 北卡：50.5%）方面的临床差异。从诊断到 1LOT 的时间以及转诊至亚专科医生的患者比例在各机构之间一致。总体而言，接受创新疗法（如 CAR-T、双特异性抗体）的患者很少（5.1%）。在 10 次访谈中，临床医生报告的限制 SOC 治疗可及性的障碍和根本原因包括患者特征、诊疗障碍、转诊/治疗方案，以及社区参与/支持资源。
结论 各本地社区在需求、能力、利益相关方和现有医疗基础设施方面各不相同。旨在改善 SOC 和新疗法可及性与采用的项目需要是多层面的，并需在设计时考虑本地实施。由区域参与者组成的本地学习网络提供了一个稳健的框架，可高效传递洞见和临床最佳实践，同时部署响应多元社区需求的本地干预。鉴于独特的环境和社区需求，一刀切的模式将不会成功。
查看英文原文 English abstract
Introduction Treatment advances in multiple myeloma (MM) have resulted in five-year survival improvements. However, gaps remain in access and adoption of standard of care (SOC) and novel therapies. As a result, variation in care persists. Project CoMMunity is a multi-center, local learning network to detect unmet needs, understand barriers impacting SOC treatment access, and address care gaps through innovative oncology partnerships and targeted interventions.
Materials/Methods A multi-method approach was used to implement an integrated local learning network among academic and community oncology practices within New York City, NY and Winston-Salem, NC. A needs assessment and co-creation session to identify barriers and solutions was performed through community roundtables with diverse stakeholders. Electronic medical record data of patients with MM were compared across communities. Clinician-reported barriers and root causes limiting access and adherence to SOC treatments were solicited through 1:1 interviews.
Results Among 12 clinicians and 4 social workers/patient advocates that participated in the roundtables, common barriers were health literacy/socioeconomic factors, limited community/academic clinical relationships, cultural/racial issues and low patient trust, complex patient priorities/medical conditions, and limited clinical trial exposure. Stakeholders indicated opportunities to support education and awareness, improve care continuity transitions among community and academic sites, and development of educational materials. Of 332 patients (NY 237; NC 95), quantitative analysis highlighted clinical variation in time from diagnosis to specialist visit (NY: 34 vs NC: 62 days), frontline therapy (1LOT) count (quadruplet, NY: 62.3% vs NC: 11.6%; triplet, NY: 34.3% vs NC: 79.0%) and stem cell transplantation incidence (NY: 30.8% vs NC: 50.5%). Time from diagnosis to 1LOT and proportion of patients referred to sub-specialists were consistent among sites. Overall, few patients (5.1%) received innovative therapies (eg, CAR-T, bispecific antibodies). Among 10 interviews, clinician-reported barriers and root causes limiting access to SOC treatment included patient characteristics, care barriers, referral/treatment protocols, and community engagement/support resources.
Conclusion Local communities vary in needs, capacity, stakeholders, and existing healthcare infrastructure. Programs striving to improve access and adoption of SOC and novel therapies need to be multi-faceted and designed with local implementation in mind. A local learning network with regional participants provides a robust framework to efficiently transfer insights and clinical best practices while deploying local interventions that are responsive to needs of a diverse community. A one size fits all model will not succeed given unique setting and community needs.
利益披露 Disclosure
C. Rodriguez, None..
J. T. Mckay, None..
A. Jabir, None..
A. Lieberman-Cribbin, None..
S. Ormond, None.
K. Brunisholz,
Johnson & Johnson Employment, Stock Option.
K. Cohn, None..
D. S. Howard, None.