New Mexico HPV Outcomes, Practice Effectiveness and Surveillance (NM-HOPES)

描述（由申请人提供）：大约15种HPV类型导致几乎所有宫颈癌；然而，目前的HPV疫苗仅覆盖2种HPV类型，导致约70%的侵袭性宫颈癌，并且对使妇女处于危险中的既定感染没有治疗效果。因此，在可预见的未来，所有女性都需要进行某种形式的常规子宫颈检查。重要的是，今天活着的大多数妇女没有接种疫苗，因此有患宫颈癌的危险。美国预防服务工作组关于宫颈癌筛查的建议已有近十年没有更新，宫颈癌筛查的绩效指标侧重于人口覆盖率，而不是对筛查和诊断检测呈阳性的妇女进行随访。为了改善美国的宫颈癌预防，我们建议在全州、系统、提供者和患者层面进行多层次评估，包括对筛查过程中的失败进行有针对性的医疗记录审查；基于人群的筛查、诊断和治疗的地理空间制图；以及在临床环境中应用基于社区的参与式方法（CBPR），以确定整个护理过程中的障碍和促进因素，包括那些可能实现以患者为中心的新型筛查方案的障碍和促进因素。我们协调的多学科项目的基石是新墨西哥州HPV巴氏涂片登记，它超越了组织监测的局限性，在全州范围内对所有宫颈癌筛查、诊断和治疗进行监督。新墨西哥州有很大比例的不同种族（即美洲印第安人和西班牙裔）、农村、贫困、医疗权利被剥夺和健康状况不同的高危子宫颈癌人口。该申请的具体目的是：1)建立新墨西哥州HPV结果、实践有效性和监测（nm - hope） prosper研究中心；2)建立一个可持续的筛查过程文件单位，提供患者在宫颈癌筛查护理过程中的数据；3)整合并资助3个研究项目，其总体目标是通过对现实世界宫颈癌筛查实践和结果与指南和创新的比较有效性评估来为实践和有针对性的干预提供信息。

DESCRIPTION (provided by applicant): 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 recommendations 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.