LEADERSHIP/ADMIN CORE

大约有15种HPV类型导致几乎所有的宫颈癌；然而，目前的HPV疫苗包括 只有两种HPV类型导致70%的浸润性宫颈癌，并且对已建立的 将女性置于危险境地的感染。因此，所有妇女都需要进行某种常规的宫颈筛查 可预见的未来。重要的是，今天在世的大多数妇女都没有接种疫苗，因此 都有患宫颈癌的风险。美国预防服务工作组关于宫颈癌的建议 近十年来，宫颈癌的筛查和绩效指标都没有更新 筛查的重点是人口覆盖率，而不是对筛查阳性和 诊断性测试。为了改善美国宫颈癌预防，我们建议在以下位置进行多层次评估 全州、系统、提供者和患者级别，包括对故障的有针对性的医疗记录审查 筛查过程；基于人群的筛查、诊断和治疗的地理空间图；以及 社区参与式方法(CBPR)在临床环境中的应用，以确定障碍和 跨护理流程的促进者，包括那些可能实现以患者为中心的新型筛查的流程 选择。我们协调的多学科计划的基石是新墨西哥州的HPV Pap注册 它通过在全州范围内对所有宫颈疾病进行监测，超越了组织监测的局限性 癌症筛查、诊断和治疗。新墨西哥州有很高比例的种族多元化 (例如，美国印第安人和西班牙人)，农村，贫困，医疗权利被剥夺，健康状况不同 宫颈癌高危人群。本申请的具体目标是：1)建立新的 墨西哥HPV成果、实践有效性和监测(NM-HOPE)PROSPR研究中心； 2)建立一个可持续的筛查程序文档股，提供患者在 宫颈癌筛查护理课程；3)整合和资助3个研究项目 提供实践信息的目的和有针对性的干预措施，由以下方面的比较效果评价予以支持 现实世界的宫颈癌筛查实践和结果与指南和创新的对比。

Approximately 15 HPV types cause virtually all cervical cancers; however, the current HPV vaccines cover only 2 HPV types causing -70% of invasive cervical cancer and have no therapeutic effect on established infections that place women at risk. Thus, all women will need some kind of routine cervical screening for the foreseeable future. Importantly, the majority of women alive today have not been vaccinated and therefore are at risk for cervical cancer. The US Preventive Services Task Force recommendation on cervical cancer screening have not been updated for nearly a decade and performance measures for cervical cancer screening focus on population coverage rather than on follow-up among women with positive screening and diagnostic tests. Toward improving US cervical cancer prevention, we propose multi-tiered assessments at the statewide, systems, provider and patient levels including targeted medical record review of failures in the screening process; geospatial mapping of population-based screening, diagnosis and treatment; and application of community-based participatory approaches (CBPR) in clinical settings to identify barriers and facilitators across the processes of care including those that may enable novel patient-centered screening options. The cornerstone of our coordinated, multidisciplinary program is the New Mexico HPV Pap Registry which transcends limitations of organizational monitoring by mandating statewide surveillance of all cervical cancer screening, diagnosis and treatment. New Mexico is home to a high proportion of ethnically diverse (i.e., American Indian and Hispanic), rural, impoverished, medically disenfranchised and health-disparate populations at high-risk for cervical cancer. The specific aims of this application are to 1) Establish the New Mexico HPV Outcomes, Practice Effectiveness and Surveillance (NM-HOPES) PROSPR Research Center; 2) Establish a sustainable Screening Process Documentation Unit providing data on patients during their course of cervical cancer screening care; and 3) Integrate and fund 3 research projects with the overarching aim of informing practice and targeted interventions supported by comparative effectiveness evaluations of real-world cervical cancer screening practice and outcomes versus guidelines and innovations.