ASPO Abstracts
Developing and implementing electronic health records-based intervention tools in a large NYC healthcare system to facilitate H. pylori eradication strategies for gastric cancer prevention
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Gastric cancer is the third most common cause of cancer mortality worldwide. ChineseAmericans experience a disproportionate burden of gastric cancer mortality. The bacteriumHelicobacter pylori (H. pylori) is the strongest risk factor for gastric cancer; H. pylorieradication through triple antibiotic therapy is the most effective prevention method.Clinician adherence to the American College of Gastroenterology H. pylori treatmentguidelines is not high. Medication adherence to the complex treatment regimen ischallenging, especially for Chinese New Yorkers for whom 61% have limited Englishproficiency and low health literacy. Purpose of the Study: Working with an advisory coalition of community and health caresafety net provider stakeholders, we developed a health-systems level intervention usingelectronic health record (EHR)-based tools to facilitate H. pylori treatment strategiesfor gastric cancer prevention. Methods: We used a mixed methods approach to inform EHR tool development, including: 1) acomprehensive scoping review of the peer reviewed and grey literature on gastric cancerprevention programs for Chinese Americans; 2) 4 site workflow analyses , which consistedof ethnographic observations and key informant interviews with 5 providers for contextualdata on organizational workflow, culture and practice; and 3) 15 key informant interviewswith community-based stakeholders and former patients. Results: Findings indicated the lack of culturally and linguistically tailored H. pyloriand gastric cancer prevention materials. Using an iterative process, we developed 3EHR-based tools: 1) a H. pylori medication order set for the most common first andsecond-line therapies; 2) basic health education materials for the patient in English andChinese; and 3) a follow-up reminder for testing in 2 months to the patient’s primary carephysician. Barriers and facilitators to implementation will be shared, including findingsfrom utilization reports on patterns of use.Conclusion: There is a need to integrate system-wide EHR-based tools for underserved,vulnerable communities to enhance and sustain evidence-based practices for treatmentadherence and cancer prevention to reduce H. pylori-related gastric cancer disparities forhigh-risk populations.
Keywords: gastric cancer,disparities, ChineseAmerican,