Breast Cancer Screening and Follow-up in a PBRN: The Ma*

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DESCRIPTION (PROVIDED BY APPLICANT): University of Arizona, Sarver Heart Center Health care organizations play a central role in improving the process of breast cancer screening and follow-up. For patients receiving regular care within a medical system, sub-optimal mammography screening rates represent a significant system-level failure in care delivery. Research efforts to overcome barriers to screening success and effective follow-up must therefore move from an exclusively patient or physician focus to include the process of care delivery within health systems. Because primary care providers (PCPs) are the key decision makers in a practice network, we hypothesize that correctly classifying patients based on linkage to a specific PCP will create a mechanism to efficiently allocate resources and interventions to change care. For patients with a close PCP linkage, interventions to improve mammography screening rates can be focused through the physician, whereas for patients who receive care (often episodic) from within the system but without close linkage to a PCP, interventions can be directed through a practice manager. We propose to closely couple identifying the right provider for a patient to the use of clinical health informatics systems that link information to action and that can be easily used independent of clinic visits to enhance primary care cancer screening. We will implement an informatics-based population management tool for use by PCPs or practice managers in a controlled trial within our Practice-Based Research Network (PBRN). Specific Aim 1: To classify all patients within the MGPC-PBRN according to patient-PCP linkage status and to describe the characteristics of patients with close linkage to a PCP ("PCP loyal") or not ("Practice loyal"). Specific Aim 2: To develop and implement a novel breast cancer screening intervention program called Mammography FastTrack to facilitate ordering and tracking of mammograms that can be used by either PCPs (for PCP-loyal patients) or by practice managers (for practice-loyal patients). Specific Aim 3: To perform a group randomized trial of the Mammography FastTrack program within the MGPC-PBRN to increase mammography screening rates in both PCP-loyal and Practice-loyal eligible patients overdue for breast cancer screening. This research is relevant to nationwide efforts to modernize and improve health information technology capabilities. We will create a process to track all patients within our PBRN and to reduce current barriers to ordering and following up of abnormal mammogram results.