Multilevel Model of Breast Cancer Follow-up Care

描述（由申请人提供）：乳腺癌筛查是无效的，除非使用适当的诊断测试来明确诊断任何潜在的癌症。尽管已经制定了最大限度地提高诊断准确性的指南，但在一项初步研究中，我们发现，14%的低收入爱荷华州妇女的筛查结果异常，根据这些指南，诊断随访是不够的。 关于乳腺癌护理质量的研究通常只包括患者因素，而忽略了妇女居住的社区也可能影响健康状况的事实。社区贫困与乳腺癌发病率和生存率以及行为独立相关，但目前尚不清楚来自社会和经济贫困程度较高地区的低收入妇女是否不太可能接受足够的诊断随访，以及造成这种差异的潜在原因是什么。拟议项目的目标是分析现有数据的2,800低收入密苏里州妇女与异常乳腺癌筛查结果，并收集近300低收入密苏里州妇女的主要数据，以测试四种不同的途径，低收入妇女从较高的贫困地区是不太可能得到足够的诊断后续在未来的R 01项目。这四个途径是：（一）对社区基础设施，包括保健的投资不足;（二）社会结构/凝聚力受到破坏;（三）居住在这些地区的妇女的个人特点是关键，而不是她们所居住地区的特点;（四）贫困直接影响到后续诊断的充分性。在拟议的研究中，我们将能够部分测试途径I，III和IV在一个多层次的概念模型，虽然不是所有的变量，这些途径将在现有的数据源。将对数据收集工具进行测试，并在发展研究中评估招募和参与的潜在偏倚。这些原始数据将构成途径二（社会凝聚力）的基础，该途径二将在未来的R 01赠款中与其他三个途径同时进行测试，以研究为什么来自社会和经济贫困程度较高地区的妇女不太可能接受充分的诊断随访。

DESCRIPTION (provided by applicant): Screening for breast cancer is not effective unless the appropriate diagnostic tests are used to definitively diagnose any potential cancer. Although guidelines have been developed to maximize diagnostic accuracy, in a preliminary study we found that 14 percent of low-income Iowa women with abnormal screening results had diagnostic follow-up that was inadequate based on these guidelines. Studies about the quality of breast cancer care have typically included only patient factors and have ignored the fact that communities in which women reside may also shape health status. Community deprivation is independently associated with breast cancer incidence and survival and with behaviors, but it is unclear if low-income women from areas with higher social and economic deprivation are less likely to receive adequate diagnostic follow-up and what the potential reasons are for such disparities. The goal of the proposed project is to analyze existing data of 2,800 low-income Missouri women with abnormal breast cancer screening results and to collect primary data of nearly 300 low-income Missouri women in order to test four different pathways by which low-income women from areas with higher deprivation are less likely to receive adequate diagnostic follow-up in a future R01 project. The four pathways are: I) under investment in community infrastructure, including health care; II) disruption of the social fabric/cohesion; III) individual characteristics of women who reside in these areas are key rather than the characteristics of the areas in which they live; and IV) deprivation directly influences adequacy of diagnostic follow-up. In the proposed study we will be able to partly test pathways I, III, and IV in a multilevel conceptual model, although not all variables for these pathways will be available in the existing data sources. Data collection instruments will be tested and potential biases in recruitment and participation will be assessed in a developmental study. These primary data will form the basis for pathway II (social cohesion), which will be tested simultaneously with the other three pathways in a future R01 grant to examine reasons why women from areas with higher social and economic deprivation are less likely to receive adequate diagnostic follow-up.