Comparative Effectiveness of Care Systems 8 Established 8 Emerging Modalities

我们建议在全球范围内进行的比较有效性研究（CER） 新英格兰协作乳腺监测网络将使用登记数据和建模来推进 以系统为基础的方法来改善乳腺癌筛查的护理过程，重点是 健康信息技术（IT）。我们提出三个具体目标：具体目标1：发展一个 描述临床实践网络站点之间筛选过程的定量建模框架， 结合项目1（筛选过程、测量和反馈）的发现，以确定高价值 筛选过程改进的目标。具体目标2：使用决策分析方法估计 并比较不同年龄段乳腺癌筛查策略的利弊 在项目2中开发和试用的风险工具中使用的视野（个性化模块， 风险）。具体目标3：比较研究中心之间和不同时间的乳腺癌筛查结局 评估涉及卫生信息技术的护理过程在新的 英国乳腺监测合作网络。我们假设，有限数量的关键属性， 可以识别与改善的筛查结果最相关的护理过程。实现 这一目标是通过筛查过程文件股获得的关于接受筛查的妇女的纵向数据， 将对数字乳腺X射线摄影进行分析，以比较过程结果、益处和危害。二次 分析将涉及数字乳腺断层合成，这是一种新兴技术， 与数字乳房X线摄影相比，在临床实践中的使用迫在眉睫。比较一个 与数字乳腺X射线摄影相关的新兴技术将为数字乳腺X射线摄影的最佳用途提供早期证据。 乳腺断层合成摄影。

The comparative effectiveness research (CER) that we propose conducting within the New England Collaborative Breast Surveillance Network, will use registry data and modeling to advance systems-based approaches to improving the processes of care for breast cancer screening with a focus on health information technology (IT). We propose three specific aims: Specific Aim 1: To develop a quantitative modeling framework that depicts screening processes across clinical practice network sites and incorporates findings from Project 1 (screening process measurement and feedback) to identity high-value targets for screening process improvement. Specific Aim 2: To use decision-analytic methods to estimate and compare the benefits and harms of alternative breast cancer screening strategies over various age horizons for use in the risk tools that will be developed and trialed within Project 2 (personalized modules for risk). Specific Aim 3: To compare breast cancer screening outcomes between study sites and across time to assess the impact that care processes involving health IT have as they are disseminated within the New England Collaborative Breast Surveillance Network. We hypothesize that a limited number of key attributes of care processes can be identified that are most associated with improved screening outcomes. To achieve this aim longitudinal data obtained by the Screening Process Documentation Unit on women undergoing digital mammography will be analyzed to compare process outcomes, benefits, and harms. Secondary analyses will address digital breast tomosynthesis, an emerging technology whose regulatory approval for use in clinical practice is imminent, in comparison with digital mammography. Comparing outcomes for an emerging technology relative to digital mammography will provide early evidence on the best uses of digital breast tomosynthesis.