This study shows evidence of sustained improvements in HIV care processes and treatment outcomes for an estimated population of 2296 HIV patients in 17 BC sites. Overall success points to opportunities for other high-income countries seeking to improve HIV health outcomes.

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124 Background: Participation in and access to cancer treatment clinical trials (CCTs) is a key measure for delivery of quality cancer care. Yet adult trial participation in the U.S. remains under 3%, with even lower participation rates among minority groups and people over 65. There is little evidence for best practices in CCT accrual. If institutions are to be evaluated by the access they provide to CCTs, it is critical to identify practical, evidence-based approaches to maximize the efficiency of CCT recruitment, accrual, and retention efforts. The National Cancer Clinical Trials Pilot Breakthrough Collaborative (NCCTBC) is the first-ever national effort to identify such best practices in a real world setting. Methods: The purpose of this pilot was to test the feasibility of applying a proven quality improvement process to CCT accrual. More than 150 evidence-based changes to processes and procedures were identified. Five community oncology practices designed, tested, and implemented changes and reported monthly on 6 core measures to gauge improvement. Teams collaborated to share challenges and were provided coaching and technical assistance by national experts. Results: Teams have tested 35 changes over a 10-month period. Outcomes from the pilot are already showing promising results in identifying those changes that can have the most impact on improving accrual. For example: Improvements in race and ethnicity data capture are helping to address disparities in patient census. Improvements in processes for trial menu selection are leading to new ways of assessing patient populations and finding trials that match them. Documentation of pre-screening and offer rates is identifying system gaps and ways to increase these rates. Conclusions: Results affirm the feasibility of applying a quality improvement framework to address persistently low accrual rates and decrease health disparities among racial and ethnic minorities and the elderly. Based on lessons learned, we are making improvements to the NCCTBC infrastructure and processes and plan to recruit 10 new teams to test further changes.