Evaluation of Guideline-based Uptake of Indicated Diagnostic exams after AbNormal Cervical cancer screening test in safEty-net settings (E-GUIDANCE)

This NIH K08 Mentored Clinical Scientist Research Career Development Award has the overall goal of designing and developing an intervention to address delays in care that occur after an abnormal cervical cancer screening test in uninsured patients served by safety-net health systems. Timely follow-up care after an abnormal cervical cancer screening test result is critical to prevent disease progression and reduce cervical cancer. Uninsured populations served by safety-net health systems tend to have high rates of cervical cancer incidence and mortality despite comparable screening rates to insured populations. This could be due to the delays in care after an abnormal screening test and the fragmentation of care that separates primary and colposcopy follow-up care in safety-net settings. The goals of this study are to (Aim 1) quantitatively investigate follow-up care after transfer from primary to gynecology specialty care, (Aim 2) qualitatively evaluate patient-, provider-, and system- level facilitators and barriers when referring for follow-up and identify potential solutions, and (Aim 3A) synthesize an intervention package targeting the bottlenecks identified in Aims 1 and 2 and (Aim 3B) assess the acceptability and feasibility of the intervention with key stakeholders. Using the Obesity-Related Behavioral Intervention Trials (ORBIT) model, a structured, systematic, and progressive approach to developing robust, effective interventions, based on the phases of drug development, this K08 will encompass the first ORBIT intervention development phase: Design. A convergent mixed methods study will be conducted to evaluate delays and identify facilitators and barriers to follow-up care after an abnormal screening result in uninsured patients served by fragmented safety-net systems. We will leverage CAPriCORN, a patient-centered outcomes research network that includes two safety-net health systems and a network of over 40 federally qualified health centers (FQHCs) in Chicago, to develop a new database with comprehensive cervical cancer follow-up data and patient-, clinic-, and system- level variables. CAPriCORN’s linkage system will support a longitudinal analysis of the fragmentation of care that may influence referral of patients from FQHCs to gynecologic specialty care housed in tertiary safety-net systems. Simultaneously, we will explore the follow-up process through interviews with healthcare teams and patients at CAPriCORN safety-net sites to investigate other multilevel facilitators and barriers to referring patients from primary to gynecologic care and potential solutions. Finally, we will synthesize an intervention package from our findings and interview key stakeholders (clinic leaders, health system leaders, providers, and patients) to evaluate the feasibility and acceptability of intervention components for further optimization. The Training Objectives of this study are to gain expertise and skills in 1) using health informatics, NLP, and data science; 2) using mixed methods designs, 3) intervention development and design, and 4) conducting clinical trials. With the K08, I will be well-positioned for future grants that continue to develop and optimize this intervention through Phases II-IV of the ORBIT model to make impacts on uninsured populations served by safety-net health systems. Project Number: 1K08CA312595-01 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Hunter Holt | Institution: UNIVERSITY OF ILLINOIS AT CHICAGO, Chicago, IL | Award Amount: $286,638 | Activity Code: K08 | Study Section: Special Emphasis Panel[ZRG1 HSS-M (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11349993