WISCONSIN BREAST AND CERVICAL CANCER SCREENING PROJECT

该项目的主要目标是展示一个联盟如何 社区卫生和社会服务机构可以共同努力 实施和评估旨在降低死亡率的战略 由于乳腺癌和宫颈癌的女性人数增加 接受常规乳房X光检查、临床乳房检查和巴氏涂片检查 建议的间隔时间。 拟议的乳房公共卫生方法 宫颈癌筛查旨在覆盖所有 40 岁女性 威斯康星州中北部四个农村县的老年人和老年人。 因为 他们进行乳腺癌和宫颈癌晚期诊断的风险较高 癌症、低收入妇女和 65 岁及以上的妇女将 专门针对干预措施。 还将重点关注 测试旨在引入结构性政策的相关策略 医疗保健提供和融资系统的改革 预计将提高农村低收入和老年人的筛查率 妇女。 一项“内展”和两项外展的随机对照研究 干预战略将在两个明确界定的低收入国家实施 人群：1）农村社区卫生服务中心挂号的患者， 2) 四个农村县的医疗补助受益人。 在第二年，这些研究的结果将是 纳入社区范围的筛查计划。 该计划将 通过区域联盟进行协调，并将涉及公众和 专业意识和教育计划。 除了 协调内联和外联活动、区域联盟和 当地工作队将负责提供技术援助和 倡导在偏远农村实施提醒制度 干预县的做法。 区域联盟将 还与当地服务提供商、保险公司和其他相关机构合作 各方加强筛查能力并制定融资机制 满足全区居民的筛查需求。 这的影响 社区范围内的干预措施将通过准实验性评估 设计，在干预中使用全人口电话调查 地区和该州的类似地区。 的评价 拟议的乳腺癌和宫颈癌筛查项目将评估 组合策略的有效性以及 选择建议的干预方法，克服个人， 筛选利用的环境和系统障碍 充分的后续行动。

The primary goal of this project is to demonstrate how a consortium of community health and social service agencies can work together to implement and evaluate strategies which are aimed at decreasing mortality due to breast and cervical cancer by increasing the number of women who receive routine mammography, clinical breast exams, and Pap testing at recommended intervals. The proposed public health approaches to breast and cervical cancer screening are designed to reach all women 40 years and older in four rural counties in north central Wisconsin. Because they are at higher risk for late stage diagnosis of breast and cervical cancer, low income women and women aged 65 years and older will be specially targeted for interventions. An emphasis will also be placed on testing policy- relevant strategies designed to introduce structural modifications in the health care delivery and financing systems that are expected to improve rates of screening among low income and elderly rural women. Randomized controlled studies of one "inreach" and two outreach intervention strategies will be conducted in two well-defined, low-income populations: 1) registered patients of a rural community health center, and 2) Medicaid beneficiaries in four rural counties. During the second year, the results from these studies will be incorporated into a community-wide screening program. This program will be coordinated through a Regional Consortium and will involve public and professional awareness and education programs. In addition to coordinating inreach and outreach activities, the Regional Consortium and local task forces will be charged with providing technical assistance and advocating for the implementation of reminder systems in isolated rural practices in the intervention counties. The Regional Consortium will also work with local service providers, insurers and other relevant parties to enhance screening capacity and develop financing mechanisms to meet the screening needs of all area residents. The impact of this community-wide intervention will be assessed by a quasi-experimental design, using population-wide telephone surveys in the intervention region and in a comparable region in the state. The evaluation of the proposed breast and cervical cancer screening project will assess the effectiveness of the combined strategies, as well as the effectiveness of selected proposed intervention methods, in overcoming individual, environmental, and systemic barriers to screening utilization and adequate follow-up.