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Designing a Plan of Action for Better Access and Quality of Surgery for African-Americans with Gastrointestinal Cancers in the Deep South

Award Number: R01MD013858
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Current evidence shows that African-Americans (AAs) with gastrointestinal (GI) cancers (colorectal, pancreatic and esophageal cancer) are less likely to undergo surgery, and suggests that those who undergo surgery may be less likely to receive best-evidence surgical care that is timely and minimizes adverse surgical outcomes. An effort to eliminate these racial/ethnic disparities is warranted especially in Alabama (AL) and Mississippi (MS). These two states of the US Deep South have high GI cancer incidence and mortality, and high mortality for AAs in particular, large AA populations, and challenges for access to quality care such as limited affordability and availability. Neither surgical care disparities nor their driving mechanisms have been examined in these states. In addition, lay navigation and Enhanced Recovery After Surgery (ERAS) are effective models on which to build a plan to eliminate surgical disparities. At our institution, the implementation of ERAS processes has led to the elimination of surgical disparities in length of stay without compromising surgical outcomes. Our long term objective is to ultimately eliminate disparities in GI cancer surgery care and outcomes by improving access to timely surgery and facilitating the adoption of ERAS in AL and MS. Our aims are to: 1) Identify gaps in surgical care for GI cancers in AL and MS. With a survey of 450 AA and 550 white GI cancer patients, and medical chart abstraction, we will assess differences for AAs and whites in i) receipt of surgery, ii) time from diagnosis to surgery, and iii) exposure to 17 ERAS processes; 2) Examine potential mechanisms of surgical disparities. Combining survey results with those of individual interviews with 48 AA and white patients and with 48 GI cancer care providers in a mixed methods integrated analysis, we will provide a comprehensive assessment of patient, provider, and system level factors that affect access to care mechanisms, i.e., whether surgery care and ERAS processes are acceptable, affordable, available, accessible and accommodating; 3) Assess the feasibility of a combined surgery-focused lay navigation and ERAS intervention in GI cancer. Results from Aims 1 an 2 will guide the development of a surgery-focused navigator program to facilitate access to timely surgery and support patients in the peri- to post- surgery phases. By accomplishing Aims 1-3, we will define: i) future intervention targets for GI cancer patients in AL and MS, i.e., populations and surgery processes; ii) mechanisms to address in order to achieve effective surgical care; and iii) a surgery focused navigation program to optimize the uptake of surgery and implementation of ERAS for AAs. Thus, the expected outcome of this project is a concrete and detailed actionable plan to eliminate surgical disparities in AL and MS. Without this significant new knowledge, progress toward the elimination of disparities in GI cancer surgery is hindered. With this plan, we will be well prepared to achieve our objective and have a high impact on the goals of the National Institute on Minority Health and Health Disparities (NIMHD) and the National Cancer Institute (NCI) to advance scientific knowledge that will help all people live longer, healthier lives, and eliminate health disparities.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2024	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH STREET	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	000	5	10/17/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $575,534 )
2024	2024	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH STREET	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	000	5	1/26/2024	NON-COMPETING CONTINUATION	$534,003
2024	2024	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH STREET	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	001	5	5/28/2024	NON-COMPETING CONTINUATION	$41,531
														Subtotal = $575,534

Issue Date FY: 2023 ( Subtotal = $597,411 )
2023	2023	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	000	4	1/20/2023	NON-COMPETING CONTINUATION	$597,411
														Subtotal = $597,411

Issue Date FY: 2022 ( Subtotal = $609,503 )
2022	2022	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	001	3	1/15/2022	NON-COMPETING CONTINUATION	$548,556
2022	2022	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	002	3	5/25/2022	NON-COMPETING CONTINUATION	$60,947
2022	2021	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	000	2	12/6/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $609,503

Issue Date FY: 2021 ( Subtotal = $624,429 )
2021	2021	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	002	2	3/15/2021	NON-COMPETING CONTINUATION	$62,442
2021	2021	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	001	2	1/22/2021	NON-COMPETING CONTINUATION	$561,987
2021	2020	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	000	1	1/7/2021	NEW	$0
														Subtotal = $624,429

Issue Date FY: 2020 ( Subtotal = $631,122 )
2020	2020	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	000	1	6/15/2020	NEW	$631,122
														Subtotal = $631,122

Grand Total All Awards = $3,037,999

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Designing a Plan of Action for Better Access and Quality of Surgery for African-Americans with Gastrointestinal Cancers in the Deep South

Award Number: R01MD013858

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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