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.

乳房X线照片异常后的筛查和及时的随访是基于证据的方法 降低了乳腺癌的发病率和死亡率，但速度仍然不佳。社区卫生中心 （CHC）努力解决这些问题，因为它们的能力和资金常常被超越 他们提供的护理数量。为了减少乳腺癌分布，我们必须扩大规模至关重要 在这些环境中弥合筛选差距的策略既有效又有效。 患者导航是一种经过良好研究的卫生服务策略，已证明可以提高 乳腺X线照片异常后的乳腺癌筛查和随访。但是，数据很少 关于CHC中航行的患病率，能力，资金和可持续性或CHC如何 没有导航员使用其他人员资源来管理筛查和后续行动。为了解决这个问题，我们 意志：（1）确定在美国的325个CHC中使用导航器和跟踪工具的程度； （2）测试是否提供跟踪功能和简短练习的低强度干预措施是否 促进性将弥合带有导航器和没有导航器的CHC中的筛选空白。 我们将调查325个CHC，以收集有关导航器和其他使用的网站特征和信息 用于解决乳腺癌筛查和随访的人员配备模型（AIM 1）。这些CHC使用 共同的人口管理平台，数据报告和可视化系统（DRV） 是由专门用于CHC环境的医疗保健分析提供商Azara Healthcare开发的， 和研究团队的亲密合作伙伴。 Azara目前正在开发新的DRVS功能以允许 CHC跟踪乳腺癌筛查中的护理差距（“ BC-SCR工具”），以便到2020年底部署。 我们将使用前/后测试设计来研究BC-SCR工具的使用”，其中一个与 导航，一个没有（目标2）。结果包括乳腺摄影和 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 练习设施将改善这些结果，并减少站点之间的任何护理差距。而网站 通过导航，可能会从这些工具中受益，这些工具使用辅助而不是专门的工作人员来 地址筛查可能会根据跟踪患者提供的效率而获得进一步的好处 临床需求。研究设计提供了初始测试，以确定是否有必要进行大规模研究。 我们将使用定性方法来评估CHC员工的干预经验（AIM 3）。 该项目将首次提供有关有关的数据，结构和稳定的数据 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，可扩展的支持截止筛选空白。该提议是及时的机会 新技术推出的优势，并在两个不同的护理环境中观察其影响。