Advancing Systems Approaches to Personal and Population Breast Cancer Screening

描述（由申请人提供）：拟议的PROSPR中心将专注于开发和评估基于系统的方法，以优化整个乳腺癌筛查连续体的护理，为个人和人群，使用健康信息技术（IT）。这种方法是及时的，因为电子健康记录（EHR）的广泛部署和“有意义的使用”为开发基于系统的解决方案提供了基础设施、机会和激励。我们将在一个由综合临床交付系统组成的区域网络内解决这些问题，该网络以初级保健为基础，通过乳腺成像，病理学和初始癌症治疗进行全面的数据采集。我们的三个全面项目/具体目标由两个核心支持，解决关键优先事项并提高护理质量：目标1：通过测量和反馈改进乳腺癌筛查系统，使用微系统方法绘制整个筛查过程，并制定可推广的指标，以评估变化、表征过程和筛查结果，并开发和实施仪表板工具，以衡量和报告这些筛选指标;目标2：通过开发一个电子健康档案综合系统，个性化的乳腺癌筛查模块将为妇女提供量身定制的风险评估和筛查建议，并为其提供者提供量身定制的决策支持。并在基于实践的随机对照试验中测量覆盖范围、有效性、采用和实施;目标3：比较已建立和新兴乳腺癌筛查模式的系统间护理过程的有效性，通过为目标1和2提供定量和人群估计来促进中心项目的整合，并评估新兴模式的影响（例如，断层合成）。我们的区域合作，经验丰富，多学科的专业知识和合作的国家乳房筛查联盟的跟踪记录，提供不同的人群和护理环境和项目，旨在提高整个乳房护理连续体的护理质量的数据。

DESCRIPTION (provided by applicant): The proposed PROSPR Center will focus on developing and evaluating systems-based approaches to optimize care across the breast cancer screening continuum, for both individuals and populations, using health information technology (IT). This approach is timely as the widespread deployment and "meaningful use" of electronic health records (EHRs) provides infrastructure, opportunity, and incentive to develop systems-based solutions. We will address these issues within a regional network comprised of integrated clinical delivery systems, based in primary care with comprehensive data capture through breast imaging, pathology, and initial cancer treatment. Our three over-arching Projects/Specific Aims, supported by two cores, address key priorities and promote the quality of care: Aim 1: To improve breast cancer screening systems through measurement and feedback using a micro-systems approach to map the entire screening process and develop generalizable metrics to assess change, characterize process and screening outcomes, and develop and implement dashboard tools to measure and report these screening metrics; Aim 2: To promote personalized decisions for breast cancer screening for women and their providers by developing an EHR-integrated, personalized breast cancer screening module that will generate tailored risk assessment and screening recommendations for women and tailored decision support for their providers. and measure the reach, effectiveness, adoption and implementation in a practice-based randomized controlled trial; Aim 3: To compare the effectiveness of care processes across systems for established and emerging breast cancer screening modalities, promoting integration across the Center's projects by providing both quantitative and population estimates for Aims 1 and 2, and to assess the impact of emerging modalities (e.g., tomosynthesis). Our regional collaborative, with seasoned, multi-disciplinary expertise and a track record of collaboration in a national breast screening consortium, offers data on diverse populations and care settings and projects that are designed to improve the quality of care across the breast care continuum.