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基于证据的方法 降低乳腺癌的发病率和死亡率，但发病率仍然不理想。社区卫生服务中心 (CHC) 很难解决这些问题，因为它们的能力和资金往往无法满足 他们提供的护理量。为了减少乳腺癌差异，我们必须扩大规模 对于缩小这些环境中的筛查差距既有效又高效的策略。 患者导航是一项经过充分研究的医疗服务策略，已被证明可以提高患者就诊率 乳房X光检查异常后的乳腺癌筛查和随访。但资料却很少 关于 CHC 导航的普遍性、能力、资金和可持续性，或者 CHC 如何做到这一点 导航员不得使用其他人力资源来管理筛查和后续行动。为了解决这个问题，我们 将：(1) 确定全美 325 个 CHC 中导航器和跟踪工具的使用程度； (2) 测试是否提供跟踪功能和简短练习的低强度干预 便利化将缩小社区卫生中心在有或没有导航员的情况下的筛查差距。 我们将调查 325 个 CHC，收集场地特征以及有关导航器和其他设备使用情况的信息。 用于解决乳腺癌筛查和随访问题的人员配置模式（目标 1）。这些 CHC 使用 通用人口管理平台，数据报告和可视化系统（DRVS） 由 Azara Healthcare 开发，Azara Healthcare 是一家专门针对 CHC 环境的医疗保健分析提供商， 也是研究团队的亲密伙伴。 Azara 目前正在开发新的 DRVS 功能，以允许 CHC 追踪乳腺癌筛查方面的护理差距（“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，其中一个使用 导航和无导航（目标 2）。结果包括乳腺 X 光检查的开放订单数量和 异常筛查后的随访时间。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站点之间的护理差距。而网站 具有导航功能的网站可能会受益于这些工具，使用辅助人员而不是专门的工作人员来 根据患者追踪效率的提高，地址筛查可能会带来进一步的好处 临床需要。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。 我们将使用定性方法来评估 CHC 员工的干预体验（目标 3）。 该项目将首次建立提供有关存在、结构和稳定性的数据 美国各地的导航程序。我们将学习如何最好地优化人力资源并提供低 成本，可扩展的支持来缩小筛选差距。这项提议是一个及时的机会，因为它需要 新技术推出的优势，并观察其在两种不同护理环境中的影响。