Researchers win grant to test new approach to overcoming roadblocks to health care delivery
BOSTON – Investigators at Boston University Clinical and Translational Science Institute (CTSI), 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) won a five-year, $8.6 million award from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS) for a project called Translating Research Into Practice (TRIP). TRIP will be implemented across six clinical sites in Boston to develop and test, and disseminate a replicable, high-quality coordination of care approach for vulnerable populations experiencing disparities.
African American women with breast cancer face disparities in time-to-treatment, quality of treatment and delayed follow up to abnormal tests. Although breast cancer mortality rates have declined significantly in the United States, African American women have a 40 percent higher chance of dying from breast cancer than white women, according to the Centers for Disease Control and Prevention. In Boston, breast cancer mortality rates decreased from 2001-2012 (the greatest decrease occurring among Latina women); however, African American women were still 25 percent more likely to die from the deadly disease, according to the Boston Public Health Commission.
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
- Resources to help navigators identify social determinants of health (e.g., food and housing insecurity)
The TRIP project will integrate these strategies into a cohesive package across six hospitals, with the goal of assisting 1100 women seeking breast cancer care over the next five years. A key aspect of the project is a clinical trial 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, a physician at BMC. "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."
"We know that for many women, breast cancer is not the worst thing in her life. Many women work hard to make sure there is enough money for food and rent," said Karen Freund, MD, MPH of Tufts Clinical and Translational Science Institute. "Many women use their time off work to get to the pediatrician's office. This means that her own health and care go on the back burner. A navigator can mean all the difference, and make sure her health is a priority."
TRIP is currently in its start-up phase, consisting of stakeholder interviews, implementation planning, and development of the registry and screening tools. Once the start-up phase is completed, academic, clinical and community partners will have four years to implement and test TRIP across the six participating hospitals.
"Boston is a city with persistent health disparities despite a wealth of world-class medical institutions. The key challenge of this project is also one of its greatest opportunities. The participating institutions will need to work together to reduce disparities as individual institutions have not been able to make much headway on this issue. This is a new model that will face challenges to implementation. But the models and tools created will offer great promise for reducing disparities in care and outcomes for other conditions and in other cities," said Haas.
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.
About Boston University Clinical and Translational Science Institute (CTSI)
The Boston University Clinical and Translational Science Institute (CTSI) is a partnership between Boston University and Boston Medical Center launched in 2008. The BU-CTSI is funded by a Clinical and Translational Science Award from the National Center for Advancing Translational Sciences, National Institutes of Health (award number UL1TR001430). The BU-CTSI serves as a center of expertise which provides tools, services, and resources to clinical and translational investigators to maximize the impact of their discoveries and speed the translation of their research to the bedside. In particular, we are committed to improving the health of vulnerable populations through novel discovery approaches and by engaging these populations in the research enterprise.
About Tufts Clinical and Translational Science Institute (CTSI)
Tufts CTSI, a National Institutes of Health
(NIH)-supported partnership among all the schools of Tufts University; Northeastern University, Brandeis University, RAND; Tufts CTSI-affiliated hospitals, and health care industry and community organizations, was established in August 2008. Its purpose is to accelerate the translation of laboratory and medical research into clinical use, widespread medical practice, and into improved health care delivery and health policy. It connects people to research resources, consultation, and education, and fosters collaboration with scholars of all disciplines and with community members, with the ultimate goal of improving the health of the public. Tufts CTSI is currently funded by the NIH National Center for Advancing Translational Sciences, award number UL1TR001064.
About Harvard Catalyst: The Harvard Clinical and Translational Science Center
Established in 2008, Harvard Catalyst | The Harvard Clinical and Translational Science Center is dedicated to improving human health by enabling collaboration and providing tools, training, and technologies to clinical and translational investigators. As a shared enterprise of the University, Harvard Catalyst is funded by the National Institutes of Health (NIH) Clinical and Translational Science Awards (CTSA) Program (grant UL1 TR001102), and by contributions from Harvard University, Harvard Medical School, Harvard T.H. Chan School of Public Health, Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Massachusetts General Hospital.
About the University of Massachusetts Center for Clinical and Translational Science (CCTS)
The UMass Center for Clinical and Translational Science (UMCCTS) was founded in 2006 to enhance clinical and translational research across the five University of Massachusetts campuses (Amherst, Boston, Dartmouth, Lowell, University of Massachusetts Medical School) and our clinical partners UMass Memorial Health Care and Baystate Medical Center. With the receipt of an NIH Clinical and Translational Science Award (CTSA) in 2010, and its successful renewal in 2015, the UMCCTS is part of a network of 62 NIH-funded centers collaborating to transform the conduct of clinical and translational research across the U.S. Other key partners include our patients and communities, foundations, biotechnology and pharmaceutical companies, and members of the venture capital and philanthropic communities. The goals of the UMCCTS are: 1) To accelerate the translation of basic discoveries into practical, cost effective solutions that improve human health; and 2) To develop and support the next generation of leaders in clinical and translational research. By supporting investigation that improves the science of translation and that accelerates the translation of UMASS discoveries into products for clinical use, we will improve the health of citizens of the Commonwealth of Massachusetts and the world.