Improving Mammography Completion and Follow-Up in Community Health Centers

改善社区卫生中心乳房 X 光检查的完成和随访

• 批准号: 10316244
• 负责人: Karen M. Emmons
• 金额: $ 8.4万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-09 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10316244
• 关键词: Address; Breast Cancer Detection; Caring; Cessation of life; Characteristics; Clinical; Country; Coupled; Custom; Data; Data Reporting; Development; Diagnosis; Diagnostic; Ensure; Funding; Geographic state; Goals; Health Personnel; Health Services; Healthcare; Incidence; Individual; Information Systems; Intervention; Interview; Learning; Low income; Mammographic screening; Mammography; Measures; Methods; Minority Women; Modeling; Morbidity - disease rate; Neighborhood Health Center; Outcome; Patients; Population; Pre-Post Tests; Prevalence; Qualitative Methods; Quality of Care; Reporting; Research; Research Design; Resolution; Resources; Sampling; Services; Site; Structure; Surveys; System; Testing; Time; Uninsured; Visualization software; Woman; base; black women; cancer health disparity; community health study; cost; data management; data visualization; design; ethnic minority population; evidence base; experience; follow-up; improved; improved outcome; malignant breast neoplasm; member; mortality; new technology; programs; racial and ethnic; scale up; screening; socioeconomic disadvantage; tool; tool development; tv watching

Screening and timely follow-up after an abnormal mammogram are evidence-based methods for reducing breast cancer morbidity and mortality, but rates remains suboptimal. Community health centers (CHCs) struggle to address these issues given that their capacity and funding is often out-stripped by the volume of care they provide. To reduce breast cancer disparities, it is essential that we scale-up strategies that are both effective and efficient to closing screening gaps in these settings. Patient Navigation is a well-studied health services strategy that has been shown to increase rates of breast cancer screening and follow-up after an abnormal mammogram. However, there is very little data about the prevalence, capacity, funding, and sustainability of navigation in CHCs, or how CHCs that do not have navigators use other staff resources to manage screening and follow-up. To address this, we will: (1) determine the extent to which navigators and tracking tools are used in 325 CHCs across the US; and (2) test whether a low-intensity intervention that provides tracking functionalities and brief practice facilitation will close screening gaps in CHCs with and without navigators. We will survey 325 CHCs to collect site characteristics and information about use of navigators and other staffing models used to address breast cancer screening and follow-up (Aim 1). These CHCs use a common population management platform, the Data Reporting and Visualization System (DRVS) which was developed by Azara Healthcare, a provider of healthcare analytics specifically for the CHC setting, and close partner of the research team. Azara is currently developing new DRVS functionalities to allow CHCs to track care gaps in breast cancer screening (“BC-SCR tools”), for deployment by late 2020. We will use a pre-/post-test design to study the use of the BC-SCR tools” in two CHCs, one with navigation and one without (Aim 2). Outcomes include number of open orders for mammography and time to follow-up after abnormal screening. We hypothesize that the BC-SCR tools, provided with brief practice facilitation, will improve these outcomes and diminish any care gaps between sites. While sites with navigation will likely benefit from these tools, sites who use ancillary, rather than dedicated, staff to address screening may experience further benefit based on efficiencies provided in tracking of patient clinical needs. The study design provides an initial test to determine if larger scale study is warranted. We will use qualitative methods to evaluate CHC staff experience with the intervention (Aim 3). This project will for the first time establish provide data about the presence, structure, and stability of navigation programs across the US. We will learn how best to optimize staff resources and provide low- cost, scalable support for closing screening gaps. This proposal is a timely opportunity in that it takes advantage of a new technology roll-out and observes its impact in two different care contexts.

异常乳房X光检查后的筛查和及时随访是一种循证的方法 减少乳腺癌发病率和死亡率，但发病率仍然不是最理想的。社区卫生中心 (社区卫生委员会)努力解决这些问题，因为它们的能力和资金往往超过 他们提供的护理数量。为了缩小乳腺癌的差距，我们扩大规模是至关重要的 有效和高效地缩小这些环境中的筛查差距的战略。 患者导航是一种经过充分研究的医疗服务策略，已被证明可以提高 乳房X光检查异常后的乳腺癌筛查和随访。然而，数据非常少。 关于CHC中导航的普及率、容量、资金和可持续性，或CHC如何做到这一点 不让导航员使用其他人员资源来管理筛查和后续工作。为了解决这个问题，我们 将：(1)确定在全美325个CHC中使用导航器和跟踪工具的程度； 以及(2)测试提供跟踪功能和简短练习的低强度干预 便利化将缩小有无导航器的社区卫生中心的筛查差距。 我们会调查325间社区健康中心，以收集场地特色及有关使用导航器和其他设施的资料。 用于乳腺癌筛查和随访的人员配置模式(目标1)。这些CHC使用一种 公共人口管理平台、数据报告和可视化系统(DRVS) 是由Azara Healthcare开发的，Azara Healthcare是一家专门针对CHC设置的医疗分析提供商， 也是研究团队的亲密合作伙伴。Azara目前正在开发新的DRV功能，以允许 CHC追踪乳腺癌筛查中的护理差距(“BC-SCR工具”)，将于2020年底部署。 我们将使用前/后测试设计来研究BC-SCR工具在两个CHC中的使用情况，其中一个具有 有导航的和没有的(目标2)。结果包括乳房X光检查的未完成订单数量和 筛查异常后进行随访的时间。我们假设BC-SCR工具，提供了简短的 实践便利化将改善这些结果，并缩小地点之间的任何护理差距。而站点 使用导航可能会从这些工具中受益，那些使用辅助人员而不是专门的员工来 根据跟踪患者的效率，地址筛选可能会获得进一步的好处 临床需求。研究设计提供了初步测试，以确定是否需要进行更大规模的研究。 我们将使用定性的方法来评估CHC工作人员对干预的体验(目标3)。 该项目将首次提供有关该病毒的存在、结构和稳定性的数据 美国各地的导航计划。我们将学习如何最好地优化员工资源并提供低成本的 成本低、可扩展的支持，用于缩小筛查差距。这项建议是一个及时的机会，因为它需要 新技术推广的优势，并观察其在两种不同护理背景下的影响。