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1 National Cancer Institute Research Agenda New Opportunities in Health Services and Outcomes Research New Opportunities in Health Services and Outcomes.

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Presentation on theme: "1 National Cancer Institute Research Agenda New Opportunities in Health Services and Outcomes Research New Opportunities in Health Services and Outcomes."— Presentation transcript:

1 1 National Cancer Institute Research Agenda New Opportunities in Health Services and Outcomes Research New Opportunities in Health Services and Outcomes Research Steven B. Clauser, Ph.D. Nancy Breen, Ph.D. Applied Research Program http://appliedresearch.cancer.gov/ Academy Health Annual Meeting San Diego June 9, 2004

2 2 Session Outline Who We Are and What We Do Who We Are and What We Do New Initiatives in Health Services Research New Initiatives in Health Services Research Improving Quality of Cancer Care Improving Quality of Cancer Care Monitoring Cancer Services: Data and Methods Monitoring Cancer Services: Data and Methods Funding Opportunities for Junior and Mid-level Investigators Funding Opportunities for Junior and Mid-level Investigators

3 Office of the Director Dr. Robert Croyle, Director Dr. Jon F. Kerner, Deputy Director for Research Dissemination & Diffusion Office of the Director Dr. Robert Croyle, Director Dr. Jon F. Kerner, Deputy Director for Research Dissemination & Diffusion Office Of Cancer Survivorship Dr. Julia H. Rowland Office Of Cancer Survivorship Dr. Julia H. Rowland Applied Cancer Screening Research Dr. Helen Meissner Applied Cancer Screening Research Dr. Helen Meissner Basic Biobehavioral Research Dr. Michael Stefanek Basic Biobehavioral Research Dr. Michael Stefanek Health Communication and Informatics Research Dr. Gary L. Kreps Health Communication and Informatics Research Dr. Gary L. Kreps Health Promotion Research Dr. Linda Nebeling Health Promotion Research Dr. Linda Nebeling Tobacco Control Research Dr. Scott Leischow Tobacco Control Research Dr. Scott Leischow Health Services and Economics Dr. Martin Brown Health Services and Economics Dr. Martin Brown Outcomes Research Dr. Joseph Lipscomb Outcomes Research Dr. Joseph Lipscomb Risk Factor Monitoring and Methods Dr. Susan Krebs-Smith Risk Factor Monitoring and Methods Dr. Susan Krebs-Smith Surveillance Research Program Dr. Brenda K. Edwards Surveillance Research Program Dr. Brenda K. Edwards Cancer Statistics Dr. Benjamin Hankey Cancer Statistics Dr. Benjamin Hankey Statistical Research and Applications Dr. Eric Feuer Statistical Research and Applications Dr. Eric Feuer Epidemiology and Genetics Research Program Dr. Edward Trapido Epidemiology and Genetics Research Program Dr. Edward Trapido Analytic Epidemiology Research Dr. Sandra Melnick Analytic Epidemiology Research Dr. Sandra Melnick Clinical and Genetic Epidemiology Research Dr. Deborah M. Winn Clinical and Genetic Epidemiology Research Dr. Deborah M. Winn Behavioral Research Program Dr. Scott Leischow, Acting Behavioral Research Program Dr. Scott Leischow, Acting Applied Research Program Dr. Rachel Ballard-Barbash Applied Research Program Dr. Rachel Ballard-Barbash Division of Cancer Control and Population Sciences

4 4 NCIs Role in Cancer Research Discovery Development Delivery Partnerships & Collaborations Interdisciplinary Science Ensure Translational Research Accelerate Application in the Clinic & Public Health Programs Integrate

5 5 Health Services Research is Relevant Across the Cancer Continuum Obesity diagnosis and management Risk Assessment Communication/ Counseling Cancer chemo- prevention Cancer Screening Recommenda- tions and Practices End-of-Life Care Use of Evidence- Based Therapies Pain Management Follow-up of cancer survivors Prevention Detection Treatment SurvivorshipDiagnosis Risk Assessment (Cancer genetics) Timely Diagnosis and Referral Cross Cutting Topics Barriers to Care Health Disparities Continuity of Care Quality of Care

6 6 * A New NCI Priority to Address a Major Public Health Concern Improving the Quality of Cancer Care

7 7 Emerging Consensus from Cancer Research and Policy Communities: Far too many of the over 9 million cancer patients and survivors in the U.S. do not receive high-quality care. Far too many of the over 9 million cancer patients and survivors in the U.S. do not receive high-quality care. In many instances, no consensus on what constitutes quality care -- especially from the patients perspective. In many instances, no consensus on what constitutes quality care -- especially from the patients perspective. Even where consensus appears to exist, wide variations in practice patterns indicate significant populations disparities in receipt of quality care. Even where consensus appears to exist, wide variations in practice patterns indicate significant populations disparities in receipt of quality care. Presidents Cancer Panel will focus on Translating Research into Clinical Practice in 2004-5 meetings. Presidents Cancer Panel will focus on Translating Research into Clinical Practice in 2004-5 meetings.

8 8 NCIs Response….. Designate Improving the Quality of Cancer Care as a priority area in the 2002, 2003, 2004, and 2005 Bypass Budget: Designate Improving the Quality of Cancer Care as a priority area in the 2002, 2003, 2004, and 2005 Bypass Budget: The Nations Investment in Cancer Research (http://plan.cancer.gov) The Nations Investment in Cancer Research (http://plan.cancer.gov)http://plan.cancer.gov Goal: Improve the quality of cancer care by strengthening the scientific basis for public and private decision making on care delivery, coverage, purchasing, regulation, and standards setting.

9 9 Defining Quality Cancer Care Quality of Care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. (Institute of Medicine, 1990) Quality of Care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. (Institute of Medicine, 1990) In the NCI Initiative, this means In the NCI Initiative, this means provision of evidence-based care across the cancer continuum provision of evidence-based care across the cancer continuum in a timely and technically competent manner in a timely and technically competent manner with good communication with good communication shared decision making shared decision making cultural sensitivity cultural sensitivity

10 10 Cancer Care Quality Improvement Cycle Measuring Outcomes that Matter Monitoring Progress and Identifying New Targets Impacting the Delivery of Care Identifying Interventions that Improve Outcomes Strengthening Science Base for Quality of Care

11 11 Cancer Care Quality Improvement Cycle Monitoring Progress and Identifying New Targets Impacting the Delivery of Care Identifying Interventions that Improve Outcomes Strengthening Science Base for Quality of Care Measuring Outcomes that Matter

12 12 To Evaluate the State of the Science in Measuring Outcomes that Matter, NCI established the Cancer Outcomes Measurement Working Group 35 internationally recognized experts, convened in 2001, drawn from academia, government, and industry 35 internationally recognized experts, convened in 2001, drawn from academia, government, and industry Not a consensus panel or advisory committee Not a consensus panel or advisory committee Rather, members analyzed literature, interacted, and made recommendations, individually, to NCI Rather, members analyzed literature, interacted, and made recommendations, individually, to NCI Focused on patient-reported outcomes Focused on patient-reported outcomes Findings forthcoming in Outcomes Assessment in Cancer (Cambridge University Press, 2004) Findings forthcoming in Outcomes Assessment in Cancer (Cambridge University Press, 2004)

13 13 Cancer Outcomes Measurement Working Group Focus on Patient-Reported Outcomes Breast Prostate Lung Colorectal Prevention Screening Treatment Survivorship End of Life HRQOL Satisfaction/Needs Economic Burden

14 14 Next Steps Post-COMWG Key Research Gaps Key Research Gaps Value-added of patient-reported outcomes (like HRQOL) beyond traditional biomedical endpoints? Value-added of patient-reported outcomes (like HRQOL) beyond traditional biomedical endpoints? Defining the concept of a clinically meaningful difference Defining the concept of a clinically meaningful difference Successfully negotiating balance between adequate responsiveness for the outcome under study while promoting comparability across studies Successfully negotiating balance between adequate responsiveness for the outcome under study while promoting comparability across studies

15 15 Cancer Care Quality Improvement Cycle Measuring Outcomes that Matter Monitoring Progress and Identifying New Targets Impacting the Delivery of Care Identifying Interventions that Improve Outcomes Strengthening Science Base for Quality of Care

16 16 CanCORS study the impact of targeted interventions on patient-centered outcomes study the impact of targeted interventions on patient-centered outcomes investigate dissemination of state-of-the-art therapies in the community investigate dissemination of state-of-the-art therapies in the community examine gaps between best, evidence-based clinical practice and actual care in community examine gaps between best, evidence-based clinical practice and actual care in community analyze disparities in quality cancer care analyze disparities in quality cancer care Can cer C are O utcomes R esearch and S urveillance Consortium: A 5-year, $34M RFA-supported cooperative agreement to:

17 17 CanCORS Study Design Established in 2001 & co-funded by NCI and VA Established in 2001 & co-funded by NCI and VA Large observational cohort study of newly identified lung and colorectal cancer patients Large observational cohort study of newly identified lung and colorectal cancer patients For lung: 5 research teams with N = 4,700 For lung: 5 research teams with N = 4,700 For colorectal: 6 research teams with N = 5,300 For colorectal: 6 research teams with N = 5,300 Socio-economically,geographically, and race/ethnically diverse samples Socio-economically,geographically, and race/ethnically diverse samples Public-private provider mix: large HMOs, fee-for- service, VA medical centers Public-private provider mix: large HMOs, fee-for- service, VA medical centers

18 18 CanCORS Study Design (cont) Rapid case ascertainment : < 3 months after diagnosis Rapid case ascertainment : < 3 months after diagnosis Follow-up patients 12 months after diagnosis Follow-up patients 12 months after diagnosis For each patient, creates a longitudinal profile of cancer care by utilization multiple data sources For each patient, creates a longitudinal profile of cancer care by utilization multiple data sources Investigate structure - process - outcome links at the patient, provider, and organizational level Investigate structure - process - outcome links at the patient, provider, and organizational level

19 19 CanCORS Specific Aims To determine how the characteristics & beliefs of cancer patients and providers and the characteristics of health-care organizations influence treatments and outcomes, spanning continuum of cancer care from diagnosis to recovery or death To determine how the characteristics & beliefs of cancer patients and providers and the characteristics of health-care organizations influence treatments and outcomes, spanning continuum of cancer care from diagnosis to recovery or death To evaluate effects of select processes of care on patients survival, health-related quality of life, and satisfaction with care To evaluate effects of select processes of care on patients survival, health-related quality of life, and satisfaction with care

20 20 Some CanCORS High-Priority Questions How and why do processes and outcomes of care vary by patient age, race, ethnicity, SES? How and why do processes and outcomes of care vary by patient age, race, ethnicity, SES? Why do high-volume hospitals tend to have lower surgical mortality rates? Why do high-volume hospitals tend to have lower surgical mortality rates? How do patients and physicians go about making treatment decisions for metastatic cancer? How do patients and physicians go about making treatment decisions for metastatic cancer? Are symptoms (especially pain and depression) treated effectively? Are symptoms (especially pain and depression) treated effectively?

21 21 Cancer Care Quality Improvement Cycle Measuring Outcomes that Matter Monitoring Progress and Identifying New Targets Impacting the Delivery of Care Identifying Interventions that Improve Outcomes Strengthening Science Base for Quality of Care

22 22 The Cancer Care Quality Measures Project (CanQual) In 2002, NCI spearheaded the creation of a public-private effort: In 2002, NCI spearheaded the creation of a public-private effort: Convened by the non-profit National Quality Forum (NQF) Convened by the non-profit National Quality Forum (NQF) Driving Questions: Driving Questions: Where are the most critical quality gaps? Where are the most critical quality gaps? How can we measure and close those gaps? How can we measure and close those gaps? How do we make these measures suitable to support QOC improvement strategies? How do we make these measures suitable to support QOC improvement strategies?

23 23 The Cancer Care Quality Measures Project (CanQual) Guided by a Steering Committee whose members (voting and liaison) are drawn from across the spectrum of organizations concerned with the quality of cancer care and performance measurement, including: Guided by a Steering Committee whose members (voting and liaison) are drawn from across the spectrum of organizations concerned with the quality of cancer care and performance measurement, including: ASCO ACS NCI ACoS ACR NCCSNCPBVA OPM CMS NCQAJCAHOONSNCCN NQF CDC AHRQ AAHP- HIAA

24 24 Focus Areas Identified by Steering Committee at Sept 2002 Meeting (Phase I completed) Tumor-site specific measures: Tumor-site specific measures: Breast cancer diagnosis and treatment Breast cancer diagnosis and treatment Colorectal cancer diagnosis and treatment Colorectal cancer diagnosis and treatment Prostate cancer diagnosis and treatment Prostate cancer diagnosis and treatment Cross-cutting measures: Cross-cutting measures: Access to care, including clinical trials Access to care, including clinical trials Communications and coordination of care (including IT uses) Communications and coordination of care (including IT uses) Prevention/Screening (including quality of screening, risk assessment, and prevention activities under purview of health systems) Prevention/Screening (including quality of screening, risk assessment, and prevention activities under purview of health systems) Symptom management and end-of-life care Symptom management and end-of-life care

25 25 CanQual Project Plan for Phase II (2004-2006) CanQual Project Plan for Phase II (2004-2006) Steering Committee (AHRQ, CMS, CDC, NCI as liaison members) Technical Panel 1 (e.g., colorectal cancer diagnosis and treatment) Technical Panel 2 (e.g., breast cancer diagnosis and treatment) Technical Panel 3 (e.g., palliative and end-of-life care) Evidence-Based Review NQF Member Councils & NQF Board Data and Methods Panel 4,5…

26 26 Selecting Measures/Research Priorities CanQual Phase II: Timeline Highlights Contract Start date Contract Start date May 3, 2004 Steering Committee selects topics July 2004 Data and Methods Panel selected and convened August 2004 3 Technical Panels selected and convened Sept. - Oct. 2004 Technical Panels deliver recommendations on coreJune 2005 - measures and future research priorities to SC Nov. 2005 Steering Committee deliver recommendations toSept. 2005 - NQF Consensus Development Process Feb. 2006 NQF 4 Member Councils, membership and Board Sept. 2005 - of Directors review and vote on measures July 2006 NQF publishes core measures of cancer care Sept. 2006 quality as voluntary consensus standards

27 27 Phase III and Beyond…... Continue to build the evidence-base for cancer quality of care measurement Continue to build the evidence-base for cancer quality of care measurement Pilot test endorsed QOC measures Pilot test endorsed QOC measures Develop new measures with public & private partners Develop new measures with public & private partners Work with partners to adopt QOC measures and evaluate their dissemination and use Work with partners to adopt QOC measures and evaluate their dissemination and use Work with provider and quality improvement organizations to implement QOC-enhancing interventions Work with provider and quality improvement organizations to implement QOC-enhancing interventions Track improvements in QOC -- and feed back findings to policy makers at all levels Track improvements in QOC -- and feed back findings to policy makers at all levels

28 28 Cancer Care Quality Improvement Cycle Measuring Outcomes that Matter Monitoring Progress and Identifying New Targets Impacting the Delivery of Care Identifying Interventions that Improve Outcomes Strengthening Science Base for Quality of Care

29 29 Building a National Cancer Data System * Overall strategy for developing a national system to track quality, access and costs of cancer care services * Data Networks * Data Resources

30 30 Key Steps Toward Building Capacity Encourage innovative use of existing data sources Encourage innovative use of existing data sources Registries (e.g., SEER, NPCR, NCDB) Registries (e.g., SEER, NPCR, NCDB) Medical records Medical records Administrative files (e.g., Medicare, Medicaid, private payers) Administrative files (e.g., Medicare, Medicaid, private payers) Surveys (e.g., NHIS, CHIS) Surveys (e.g., NHIS, CHIS) Accelerate development and linkage of multiple data sources to Accelerate development and linkage of multiple data sources to Enhance timeliness, scope, and level of detail in monitoring population Enhance timeliness, scope, and level of detail in monitoring population Capture complexity of cancer care to facilitate advanced statistical modeling of structure-process- outcome relationships Capture complexity of cancer care to facilitate advanced statistical modeling of structure-process- outcome relationships

31 31 Health Services Research Networks National, multi-site research networks that National, multi-site research networks that Can enroll large cohorts of individuals Can enroll large cohorts of individuals Track receipt of cancer control services longitudinally at the patient, provider, and health system levels Track receipt of cancer control services longitudinally at the patient, provider, and health system levels Investigate impact of interventions on patient- centered outcomes Investigate impact of interventions on patient- centered outcomes Current Examples Current Examples Breast Cancer Surveillance Consortium (BCSC) Breast Cancer Surveillance Consortium (BCSC) Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) Cancer Research Network (CRN) Cancer Research Network (CRN)

32 32 Cancer Research Network Initiated in 1999 to create a population research laboratory in the context of health care delivery systems Initiated in 1999 to create a population research laboratory in the context of health care delivery systems Research on cancer prevention, early detection, treatment, and post treatment surveillance Research on cancer prevention, early detection, treatment, and post treatment surveillance Collaborative cancer research among health care provider organizations oriented to community care Collaborative cancer research among health care provider organizations oriented to community care Access to large, stable and diverse populations Access to large, stable and diverse populations Existing integrated data-bases that can provide patient level information Existing integrated data-bases that can provide patient level information

33 33 GHC Ctr for Health Studies - Lead Site KPH Ctr for Health Research, Honolulu HealthPartners Research Foundation Henry Ford Health System KPNC Division of Research KPSC Research & Evaluation KPNW Ctr for Health Research KP-Center for Clinical Research KP-Center for Clinical Research Harvard Pilgrim Health Care Meyers Primary Care Institute Cancer Research Network Sites * KP = Kaiser Permanente

34 > Hospice Home Health Project DETECT Plan Leaders Providers HIT Study Plan Leaders Providers BARRIERS Providers Tumor Registry Enrollment Hospitalization Ambulatory visits Long-term care HMO Structure Diagnostic Imaging Pharmacy IRB CRN Population Research Laboratory CRN Plan Policy Surveys Data Resources Coordinating Center: Meta - data Surveys Plan level data Person level data Participating Plans: GHC HPHC HPRF HFHS KPH KPNC KPNW KPRM KPSC MEYERS 8.7 million covered lives Linked on Medical Record # Chart Reviews Cancer Registry Health plan - based Member surveys CRN Project - Population - based (e.g., HEDIS) Demographics Enrollment Claims Costing Methods Death Files Administrative Systems Pharmacy Laboratory Radiology Pathology Hospitalization Ambulatory Care Medical Systems specific >3% U.S. Population

35 35 CRN Projects Core Core Tobacco Cessation – Project HIT ( H MOs I nvestigating T obacco) Tobacco Cessation – Project HIT ( H MOs I nvestigating T obacco) Breast and Cervical Cancer Screening – Project DETECT ( D iagnosing E arly T umors E ases C ancer T reatment) Breast and Cervical Cancer Screening – Project DETECT ( D iagnosing E arly T umors E ases C ancer T reatment) Outcomes of Prophylactic Mastectomy and Early Screening in High Risk Women – Project PROTECTS ( Pro gram T esting E arly C ancer T reatment and S creening) Outcomes of Prophylactic Mastectomy and Early Screening in High Risk Women – Project PROTECTS ( Pro gram T esting E arly C ancer T reatment and S creening) Others CanCORS, IMPACT, Pilot Study of Disenrollment among HMO Patients with Cancer Others CanCORS, IMPACT, Pilot Study of Disenrollment among HMO Patients with Cancer

36 36 Health Services Research at NCI: Research Resources National Surveys National Surveys National Health Interview Survey – Cancer Control Topical Module, 1987, 1992, 2000 National Health Interview Survey – Cancer Control Topical Module, 1987, 1992, 2000 California Health Interview Survey, 2000 California Health Interview Survey, 2000 National Survey of Mammography Facilities, 1992 National Survey of Mammography Facilities, 1992 National Survey of Colorectal Screening in Healthcare Organizations, 2000 National Survey of Colorectal Screening in Healthcare Organizations, 2000 National Survey of Cancer Genetic Screening, 2000 National Survey of Cancer Genetic Screening, 2000 Database Resources Database Resources SEER – Medicare Linked Database SEER – Medicare Linked Database Cancer Research Network Cancer Research Network

37 37 Percentages are standardized to the 2000 Projected U.S. Population by 5-year age groups. 1 National Health Interview Survey 2 http://healthservices.cancer.gov/seermedicare/considerations/testing.htmlhttp://healthservices.cancer.gov/seermedicare/considerations/testing.html 3 U.S. Preventive Services Task Force. Guide to clinical preventive services: an assessment of the effectiveness of 169 interventions. Baltimore: Williams & Wilkins, 1989 for mammography and Pap test recommendations. U.S. Preventive Services Task Force. Guide to clinical preventive services, 2nd ed. Washington, DC: Office of Disease Prevention and Health Promotion, U.S. Government Printing Office, 1996 for FOBT and CRE. PAP smear: Within the last 3 years, age 25+ Mammogram: Within the last 2 years, age 40+ FOBT: Fecal Occult Blood Test within the last year, age 50+ CRE: Colorectal endoscopy within the last 3 years, age 50+ PSA: Prostate Specific Antigen test within the past year, age 50+ Recent Use of Cancer Screening Tests¹, Initiation of Medicare Coverage², and USPSTF guidelines³: 1987, 1992, 1998, 2000 USPSTF guidelines Initiation of Medicare coverage

38 38 CHIS 2001NHIS 2000 Latino11,8405,147 White34,38321,347 Other race182290* Asian3,809865 African American2,4974,492 Two or more races2,10433 American Indian/Alaska Natives424200 Native Hawaiian & Other Pacific Islander (NHOPI) 189* 55,42832,374 *Other race in the NHIS includes NHOPI CHIS and National Health Interview Survey (NHIS): Size of Samples

39 39 California Health Interview Survey (CHIS): Designed to Inform Local Health Actions Sollicited data and health needs from communities, tribes, and health departments Adult Interview Topic Areas (ages 18 and above) Age, gender, race, ethnicity Physical activity Health status Health use and access Health conditions Cancer screening Health insurance Health behaviors Employment Diet Income Department of Health Services Public Health Institute California Endowment NCI CDC IHS

40 40 Content of Cancer Module (2000) Screening Use and follow up Risk Factors Diet & nutrition Vitamin supplements Fruit & vegetable consumption Physical Activity Smoking Family History of Cancer Genetic screening NHISCHIS XXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXX

41 41 What are the SEER - Medicare data? The SEER-Medicare data are the result of the linkage of two large population-based sources of data: SEER cancer registry data and Medicare claims from CMS The SEER-Medicare data are the result of the linkage of two large population-based sources of data: SEER cancer registry data and Medicare claims from CMS Medicare data are longitudinal, with claims for all covered health services from the time of eligibility to death. Claims come from all types of providers, e.g. hospitals, physicians, outpatient clinics, hospice, etc. Medicare data are longitudinal, with claims for all covered health services from the time of eligibility to death. Claims come from all types of providers, e.g. hospitals, physicians, outpatient clinics, hospice, etc. Medicare data are also available for a 5% random sample of persons residing in the SEER areas who have not been diagnosed with cancer. These files can be used to create comparison groups as well as population-based rates of testing and treatment. Medicare data are also available for a 5% random sample of persons residing in the SEER areas who have not been diagnosed with cancer. These files can be used to create comparison groups as well as population-based rates of testing and treatment.

42 42 $$$$$$$$$$$ HSR Funding Opportunities at NCl

43 43 NCI Funding Mechanisms for Junior and Mid-level Investigators K-Awards NCI – Training Awards K-Awards NCI – Training Awards R03 – Small Research Grants R03 – Small Research Grants R21 – Exploratory/Developmental Grants R21 – Exploratory/Developmental Grants R01 – Research Projects R01 – Research Projects http://deainfo.nci.nih.gov/flash/awards.htm http://deainfo.nci.nih.gov/flash/awards.htm http://deainfo.nci.nih.gov/flash/awards.htm

44 44 Review Process for a Research Grant Initiate Research Idea National Institutes of Health Center for Scientific Review Study Section Institute Advisory Councils and Boards Institute Director Assign to IC IRG (Study Section) Review for Scientific Merit Evaluate for Relevance Recommend Action Takes Final Action Submit Application Allocate Funds

45 45 Minority Investigator Career Development Workshop http://www.scgcorp.com/micdw2004/ In response to the concern that racial and ethnic minority researchers have been historically underrepresented among NIH funded investigators, the NCI is sponsoring a workshop to provide training to mid-career and/or transitioning investigators from underrepresented racial/ethnic groups to enhance their ability to compete for NIH funding by providing information that will facilitate professional growth and development and increase technical skills. In response to the concern that racial and ethnic minority researchers have been historically underrepresented among NIH funded investigators, the NCI is sponsoring a workshop to provide training to mid-career and/or transitioning investigators from underrepresented racial/ethnic groups to enhance their ability to compete for NIH funding by providing information that will facilitate professional growth and development and increase technical skills. The workshop will be in Palm Desert, CA July 21-July 23, 2004. The workshop will be in Palm Desert, CA July 21-July 23, 2004. Travel support will be provided to a limited number of participants. Travel support will be provided to a limited number of participants. Contact: Vickie L. Shavers, PhD email: shaversv@mail.nih.gov shaversv@mail.nih.gov

46 46 Support for Extramural Investigators Who Want to Use the SEER-Medicare Data NCI offers technical support for data users through: NCI offers technical support for data users through: Extensive SEER-Medicare WEB page Extensive SEER-Medicare WEB pagehttp://healthservices.cancer.gov/seermedicare/ Data users conferences Data users conferences Medical Care supplement Medical Care supplement Special projects related to methods development Special projects related to methods development There are 2 (PAs) that are support SEER-Medicare projects: There are 2 (PAs) that are support SEER-Medicare projects: Economic Studies In Cancer Prevention, Screening And Care (PA-02-006) Economic Studies In Cancer Prevention, Screening And Care (PA-02-006) Cancer Surveillance Using Health Claims-Based Data System (PA-02-005) Cancer Surveillance Using Health Claims-Based Data System (PA-02-005)

47 Academy Health Annual Research Meeting, June 2004 PAR 04-036: Colorectal Cancer Screening in Primary Care Practice Utilization of CRC screening in the general population is low. Utilization of CRC screening in the general population is low. CRC screening delivery by primary care physicians is less than optimal. CRC screening delivery by primary care physicians is less than optimal. Few U.S. health plans have systems in place for CRC screening recruitment and/or results tracking. Few U.S. health plans have systems in place for CRC screening recruitment and/or results tracking. Carrie Klabunde, Ph.D. E-mail: ck97b@nih.gov ck97b@nih.gov Phone: 301-402-3362

48 48 Types of Studies PAR 04-036 is Intended to Promote Delivery: Delivery: Novel ways of integrating CRC screening into primary care practice. Novel ways of integrating CRC screening into primary care practice. Risk assessment; time to completion of tests; procedure quality. Risk assessment; time to completion of tests; procedure quality. Utilization: Utilization: Interventions, mechanisms, or systems to improve screening compliance. Interventions, mechanisms, or systems to improve screening compliance. Measures, scales, or instruments to assess screening adherence over time and with multiple modalities. Measures, scales, or instruments to assess screening adherence over time and with multiple modalities. Outcomes: Outcomes: Test performance characteristics and factors influencing these in community practice. Test performance characteristics and factors influencing these in community practice. Adverse events. Adverse events.

49 49 For further information on anything presented today -- including most appropriate NCI contacts, email…. Steven Clauser Ph.D., Senior Scientist Clausers@mail.nih.gov Nancy Breen Ph.D., Economist Breenn@mail.nih.gov Applied Research Program


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