Using Modifiable Risk Factors to Predict Inferior Care and Survival after Breast Cancer Diagnosis: A Novel Approach to Addressing Health Disparities

研究总结/摘要 尽管美国乳腺癌死亡率总体下降，但乳腺癌死亡率的显著差异 治疗和结果持续存在。与艾滋病相关的、生物学的、心理社会的和提供者特定的因素 以前被证明与乳腺癌诊断后的差异有关的，总体上， 难以或不可能改变的静态系统或个体特征。作为一种替代方法， 为了解决乳腺癌的差异，我们建议建立一个乳腺癌风险预测模型。 低生存率和护理（BRISC），它结合了动态的，可改变的风险因素，以确定妇女在 最大的风险是在诊断为乳腺癌后，护理受到影响，生存率更低。在显影之后 和验证，我们将使用BRISC模型进行统计模拟和成本计算活动，以估计 价值的提高（即，通过实施保健方案所取得的成果（每支出1美元保健费用） 高影响力、风险调整干预措施，以促进接受与指南一致的乳腺癌治疗。 最后，我们将开发一个简约的，基于临床的数据收集工具，由患者完成， 提供者，目的是将BRISC模式作为常规肿瘤护理的一部分进行操作。

RESEARCH SUMMARY / ABSTRACT Despite overall declines in breast cancer mortality in the United States, significant disparities in breast cancer treatment and outcomes persist. Access-related, biological, psychosocial, and provider-specific factors previously demonstrated to be associated with disparities after breast cancer diagnosis are, on the whole, static systemic or individual features that are difficult or impossible to change. As an alternative approach to addressing disparities in breast cancer, we propose creating a risk prediction model for Breast cancer Risk of Inferior Survival and Care (BRISC) that incorporates dynamic, modifiable risk factors to identify women at greatest risk for compromised care and worse survival after diagnosis with breast cancer. After development and validation, we will use the BRISC model to conduct statistical simulations and costing activities to estimate the improvement in value (i.e., outcomes achieved per health-care dollar spent) achieved via implementation of high-impact, risk-modifying interventions to facilitate receipt of guideline-concordant breast cancer treatment. Finally, we will develop a parsimonious, clinic-based data collection tool to be completed by patients and providers for the purpose of operationalizing the BRISC model as a component of routine oncologic care.