Implementing a Tracking & Feedback Registry to Allay Cancer Therapy Disparities

实施跟踪

• 批准号: 8520249
• 负责人: Nina A. Bickell
• 金额: $ 57.6万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8520249
• 关键词: Adjuvant; Adjuvant Therapy; Aftercare; Area; Breast Cancer Treatment; Cancer Etiology; Cancer Patient; Caring; Cessation of life; Characteristics; Climate; Computer software; Consultations; Diagnosis; Disease; Effectiveness; Ensure; Failure; Feedback; Grant; Health Services Accessibility; Hispanics; Hospitals; Human Resources; Intervention; Interview; Measures; Medical; Medical Oncologist; Medical Oncology; Methods; Minority; Minority Groups; Oncologist; Online Systems; Operative Surgical Procedures; Outcome; Pathologist; Pathology; Patients; Population; Pre-Post Tests; Primary Care Physician; Process; Provider; Radiation; Radiation Oncologist; Radiation Oncology; Randomized; Randomized Controlled Trials; Recruitment Activity; Registries; Site; Staging; Structure; Surgeon; System; Testing; Woman; Work; arm; base; cancer therapy; design; electronic data; experience; health care quality; high risk; innovation; laptop; malignant breast neoplasm; oncology; post intervention; public health relevance; randomized trial; response; tumor registry

DESCRIPTION (provided by applicant): Breast cancer is the second most common cause of cancer death in women. Black women are less likely than white women to develop breast cancer but, they are more likely to die of the disease. Some of this survival discrepancy is likely due to underuse of adjuvant therapies proven to increase survival. Breast cancer treatment often requires coordination among surgeons, pathologists, primary care physicians, medical and radiation oncologists. In NYC, black and Hispanic women who accessed care and underwent surgical treatment of their breast cancer were twice as likely as whites to experience underuse of adjuvant treatment. Disturbingly, 1/3 of these underuse cases were episodes in which the surgeon recommended treatment, the patient did not refuse and yet, care did not ensue. Underuse in such circumstances is attributable to system failures than to specific provider or patient factors. In this proposed randomized controlled trial, we aim to test the effectiveness of a Tracking and Feedback (T&F) registry innovation to increase rates of completed oncology consultation and reduce both underuse of needed adjuvant therapy and racial disparities in receipt of these treatments. We also aim to assess the feasibility of implementing a T&F Registry in these high-risk hospitals by evaluating implementation effectiveness for that innovation. We have recruited 11 hospitals that serve large proportions of minority women with breast cancer. We will randomize hospitals and aim to recruit 540 women with a new breast cancer, 270 per intervention arm. We choose these "high risk" hospitals because they serve predominantly minority populations, and such hospitals have higher rates of the system failure cause of underuse, and particularly, the type of underuse targeted by our Tracking and Feedback Registry.

描述(申请人提供)：乳腺癌是导致女性癌症死亡的第二大原因。黑人女性患乳腺癌的可能性比白人女性低，但她们死于乳腺癌的可能性更大。这种存活率差异中的一部分可能是由于未充分使用被证明可提高存活率的辅助治疗。乳腺癌的治疗通常需要外科医生、病理学家、初级保健医生、内科和放射肿瘤学家之间的协调。在纽约市，获得治疗并接受乳腺癌手术治疗的黑人和西班牙裔女性经历辅助治疗不足的可能性是白人的两倍。令人不安的是，这些未充分利用的病例中有三分之一是外科医生建议治疗的病例，患者没有拒绝，但也没有接踵而至的护理。在这种情况下，使用不足可归因于系统故障，而不是特定的提供者或患者因素。在这项拟议的随机对照试验中，我们的目标是测试跟踪和反馈(T&F)登记创新的有效性，以增加完成肿瘤学会诊的比率，并减少所需辅助治疗的使用不足和接受这些治疗的种族差异。我们还旨在通过评估这项创新的实施效果，来评估在这些高风险医院实施T&F登记处的可行性。我们招募了11家医院，为大部分患有乳腺癌的少数民族妇女提供服务。我们将对医院进行随机抽样，目标是招募540名患有新乳腺癌的女性，每个干预组270人。我们之所以选择这些“高风险”医院，是因为它们主要服务于少数族裔人群，而这类医院因使用不足而导致系统故障的比率较高，尤其是我们的跟踪和反馈登记处所针对的使用不足类型。