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

描述（由申请人提供）：亚利桑那大学萨弗心脏中心卫生保健组织在改善乳腺癌筛查和随访过程中发挥着核心作用。 对于在医疗系统内接受常规护理的患者，乳房X线摄影筛查率低于最佳水平代表着护理提供方面的重大系统级失败。因此，为克服筛查成功和有效随访的障碍而开展的研究工作，必须从单纯关注患者或医生，转向将保健服务过程纳入卫生系统。由于初级保健提供者（PCP）是实践网络中的关键决策者，我们假设，根据与特定PCP的联系对患者进行正确分类将创建一种机制，以有效地分配资源和干预措施来改变护理。对于与PCP有密切联系的患者，可以通过医生集中干预以提高乳腺X线摄影筛查率，而对于从系统内接受护理（通常是偶发性的）但与PCP没有密切联系的患者，可以通过实践经理指导干预。我们建议紧密结合确定合适的供应商为患者使用的临床健康信息系统，链接信息的行动，可以很容易地使用独立的诊所访问，以加强初级保健癌症筛查。我们将实施一个基于信息的人口管理工具，供PCP或实践管理人员在我们的基于实践的研究网络（PBRN）的对照试验中使用。具体目标1：根据患者-PCP连锁状态对MGPC-PBRN中的所有患者进行分类，并描述与PCP密切连锁（“PCP忠诚”）或不与PCP密切连锁（“实践忠诚”）的患者的特征。具体目标二：开发和实施一种名为乳腺X线检查快速跟踪的新型乳腺癌筛查干预计划，以促进可由PCP（用于PCP忠诚患者）或实践经理（用于实践忠诚患者）使用的乳腺X线检查的订购和跟踪。具体目标3：在MGPC-PBRN中进行一项乳腺X线摄影快速跟踪计划的分组随机试验，以提高对PCP忠诚和实践忠诚的合格患者的乳腺X线摄影筛查率。这项研究与全国努力实现现代化和提高卫生信息技术能力有关。我们将创建一个流程来跟踪我们PBRN内的所有患者，并减少当前订购和跟踪异常乳房X光检查结果的障碍。

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.