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Enhancing Healthcare Delivery Research at the National Cancer Institute

Ann M. Geiger, MPH, PhD; Ashley W. Smith, PhD, MPH; Sarah C. Kobrin, PhD, MPH; and Stephen H. Taplin, MD
The National Cancer Institute's Division of Cancer Control and Population Sciences created the Healthcare Delivery Research Program in January 2015, recognizing the need for empirical evidence to address cancer care challenges.
Healthcare Assessment Research Branch
 
The Healthcare Assessment Research Branch supports research focused on demographic, social, economic, and health-system factors as they relate to access to, and provision of, cancer care at the population level rather than the individual level. Of particular interest is research on patterns of care, outcomes of healthcare ser­vices, and healthcare disparities. The branch also supports research examining the financial burden of cancer care on cancer patients, survivors, caregivers, and families, including direct (eg, co-pays and indebtedness) and indirect (eg, employment and time) costs. Policy research, such as that into reimbursement strategies and behavioral economics, is of interest as it relates to patient outcomes. Studies supported by this branch often involve population-based data linkages or research networks that are a source of information on patients, clinicians, practice settings, and insurance coverage.
 
The Healthcare Assessment Research Branch manages several research resources that facilitate the work of external scientists or reporting on national cancer control trends. A data linkage of national cancer registry and Medicare claims data has been widely used to explore cancer etiology, treatment patterns, and survivor­ship issues.12 Similarly, the addition of cancer-relevant questions to a national survey of individual spending on healthcare has provided insights into the financial burden of cancer.13 The branch also works with other federal partners to coordinate the cancer portion of a national survey of individual health that is used to monitor prevention behaviors, screening rates, and other aspects of cancer control.14 Finally, the branch conducts patterns-of-care studies designed to assess the diffusion of, and possible disparities in, the use of new therapies.15
 
FUTURE DIRECTIONS
 
Staff across the Healthcare Delivery Research Program are en­gaged in several efforts to expand cancer care delivery. Funding opportunities have been developed to encourage work in emerg­ing areas such as caregiving,16 de-implementation,17 treatment disparities,18 and system strategies to promote HPV vaccination.19 Program staff are using innovative grant-making mechanisms like the Small Business Innovation Research Program, which currently seeks applications for digital platforms to support cancer caregiving20 and informatics tools to measure cancer care coordination.21 Efforts to enhance current initiatives are ongoing, including a plan to renew funding for a network that focuses on improving cancer screening processes22 and promotion of cancer care delivery research within a network of community-based cancer practices historically focused on clinical trials.23 Several proposals for funding opportunities are moving through the NCI development and approval processes.
 
The program also convenes workshops to explore areas that may benefit from new funding opportunities or research resources, most recently on cancer caregiving; consequences of shared decision making; designing delivery systems and information technology interfaces with the user in mind; employment issues experienced by cancer patients and survivors; and new opportu­nities for data linkages. In addition, the program partnered with a nonfederal organization to hold the national conference, “Cancer Care Delivery in a Rapidly Changing Healthcare System.”24 Staff also participate in national scientific meetings and engage with the research and clinical communities in many settings.
 
CONCLUSION
 
The Healthcare Delivery Research Program at NCI was formed to address the need for empirical evidence to support challenges in cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care. The program currently includes 3 compo­nents with complementary interests:
• Patient experiences and health outcomes
• Delivery system context
• Access, utilization, and outcomes at the population level

This structure and the activities described above may be modified in the future as the program responds to evolving research prior­ities of the Division and NCI. Continuous growth of the program will occur under the guidance of its first permanent leader, Paul Jacobsen, PhD, who joined NCI in September 2016. Over the next few years, program staff will continue to work toward meeting the mission of advancing innovative research to improve cancer care in service to the ultimate vision of optimal health outcomes for individual, families, and communities affected by cancer.




Ann M. Geiger, MPH, PhD, is chief, Healthcare Assessment Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute.

Ashley W. Smith, PhD, MPH, is chief of the Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute.

Sarah C. Kobrin, PhD, MPH, is acting branch chief, Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute.

Stephen H. Taplin, MD, is the deputy associate director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute.

Address for correspondence
Ann M. Geiger, MPH, PhD
Chief
Healthcare Assessment Research Branch
National Cancer Institute
9609 Medical Center Boulevard
Rockville, MD 20850
E-mail: ann.geiger@nih.gov

The opinions expressed in this article are the authors’ own and do not reflect the view of the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, or the United States government.

Acknowledgements
We would like to recognize the many contributions of the Healthcare Delivery Research Program staff in developing the program descriptions and activities described herein. Thank you to Alyssa Grauman for her comments on an early draft of this manuscript.

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