Leveraging Health Systems to Optimize Regional Cancer Care Delivery

The dominant trend in healthcare is regional consolidation of hospitals into “hub-and-spoke” health systems. Integrated care across health systems should ensure that multidisciplinary cancer care is coordinated; yet, healthcare silos persist, perpetuating differences in care among individuals. I am a colorectal surgeon and trained health services researcher working in a spoke hospital of an academic health system with a view into the realities of regional consolidation of hospitals. This proposal seeks to study colon cancer as a test case for regional cancer care delivery across hub-and-spoke health systems. Colon cancer is common, ranges in clinical complexity, follows well-established guidelines, and demonstrates known variation in quality. We will leverage the unique portfolio of the collaborative quality initiatives (CQIs) in Michigan to serve as a learning laboratory. First, we will link data from rich claims and registry data sets with health system identifiers to profile quality of multidisciplinary colon cancer care across hospitals within health systems (Aim 1). Second, we will conduct focus groups with stakeholders including multidisciplinary providers, administrative leaders, and patient representatives to characterize determinants to regional coordination of colon cancer care in health systems (Aim 2). Using a convergent mixed methods design, we will elicit qualitative determinants to regional cancer care delivery within the six World Health Organization (WHO) health systems framework domains and quantify participant’s anticipated impact of determinants on clinical outcomes over time. By integrating qualitative and quantitative data, we expect to characterize how determinants differentially influence clinical outcomes at different hospitals within the hub-and-spoke model. Third, we will design a multilevel intervention based on the Implementation Research Logic Model (IRLM) which aligns determinants, implementation strategies, and outcomes (Aim 3). The proposed work will build on my existing quantitative and qualitative skill sets with additional training in (1) performance assessment of hospitals and health systems, (2) systems science approaches including systems thinking and systems dynamics, (3) implementation research in learning health systems, and (4) the pathway to research independence. Aligned with my research and career development goals, I will be mentored by a strong multidisciplinary team with a long track record of success supporting trainees from K- to R-level funding. This proposal addresses “Healthcare Teams and Cancer Care Delivery,” a cross-cutting research priority area outlined by the NCI’s Healthcare Delivery Research Program, which seeks to influence broad access to high-quality cancer care. With the proposed training and mentorship plans, this work will propel me towards independent funding as a surgeon-systems scientist, embedded in the community, with a future R01 hybrid effectiveness-implementation trial. Project Number: 1K08CA300920-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Calista Harbaugh | Institution: UNIVERSITY OF MICHIGAN AT ANN ARBOR, ANN ARBOR, MI | Award Amount: $293,430 | Activity Code: K08 | Study Section: Special Emphasis Panel[ZRG1 CTH-K (83)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11299640