Disparities in Abnormal Mammogram Follow-up: Actionable Communication and Care Coordination Strategies

异常乳房X光检查随访的差异：可行的沟通和护理协调策略

• 批准号: 9198491
• 负责人: LEAH S KARLINER
• 金额: $ 13.79万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198491
• 关键词: Address; Advanced Malignant Neoplasm; Affordable Care Act; African American; Anxiety; Area; Benign; Biopsy; California; Caring; Characteristics; Communication; County; Data; Development; Diagnostic; Ethnic group; Future; Goals; Gynecologist; Healthcare Systems; Individual; Insurance; Intervention; Intervention Studies; Interview; Investigation; Latina; Lead; Malignant Neoplasms; Mammography; Mental Depression; Minority; Patients; Performance; Personal Communication; Physicians; Population; Preventive service; Primary Health Care; Process; Race; Radiology Specialty; Recommendation; Recording of previous events; Recruitment Activity; Registries; Reporting; Resolution; Resources; San Francisco; Surveys; System; Testing; Time; Woman; Work; base; breast cancer diagnosis; cancer care; cost; experience; follow-up; improved; malignant breast neoplasm; mammography registry; personalized intervention; psychological distress; psychological outcomes; public health relevance; socioeconomics; successful intervention

 DESCRIPTION (provided by applicant): Lack of timely follow-up of an abnormal mammogram result can lead to a delay in breast cancer diagnosis, and in turn a more advanced cancer. Moreover, delays in resolution (defining the abnormality as either cancer or benign) often cause psychological distress, including anxiety and depression. Multiple studies have found delays in resolution to be common, and more prevalent for minority than for white women. Under the Affordable Care Act more underserved women are expected to establish primary care and receive preventive services such as mammograms. With this influx of more vulnerable women into the healthcare system, it is important to understand what strategies contribute to timely follow-up specifically for this population. The overarching goal of this proposal is to inform the development of a system intervention to decrease disparities in timeliness of abnormal mammogram follow-up for vulnerable women. This proposal is based in the San Francisco Mammography Registry (SFMR), a registry of all women having mammograms at twelve participating radiology facilities in two Northern California counties. Our preliminary work has categorized SFMR facilities as having either timely or delayed follow-up. This proposal builds upon that work by testing candidate actionable systems-based communication and care coordination strategies with women and referring physicians. Our investigation encompasses the following specific aims: Aim 1. Test candidate areas for improvement from our radiology facility data utilizing interviews with vulnerable women about their experiences, and elicit additional experiences with communication and coordination of care after an abnormal mammogram result, perceived system facilitators and barriers to timely follow-up, and specific recommendations for system improvements to facilitate timely follow-up. Aim 2. To a) test candidate areas for improvement from our radiology facility and Aim 1 data, utilizing a survey of referring physicians about their experiences with follow-up of abnormal mammograms; and, in order to identify those specific factors with the most potential for intervention, investigate b) physician perceived acceptability and feasibility of the women's recommendations for system improvements and, c) the association of facility characteristics with physician report of facility performance on communication, access and care coordination.

 描述（由申请人提供）：缺乏对异常乳房X线检查结果的及时随访可能导致乳腺癌诊断延迟，进而导致更晚期的癌症。此外，延迟解决（将异常定义为癌症或良性）通常会导致心理困扰，包括焦虑和抑郁。多项研究发现，延迟解决问题是常见的，少数民族妇女比白色妇女更普遍。根据《平价医疗法》，预计将有更多得不到充分服务的妇女建立初级保健，并接受乳房X光检查等预防性服务。随着越来越多的弱势妇女涌入医疗保健系统，了解哪些策略有助于专门针对这一人群进行及时随访非常重要。该提案的总体目标是为制定系统干预措施提供信息，以减少弱势妇女在乳房X线检查异常后续行动及时性方面的差距。该提案基于弗朗西斯科乳房X光检查登记处（SFMR），该登记处是北方加州两个县的12个参与放射学设施中所有接受乳房X光检查的妇女的登记处。我们的初步工作已将SFMR设施分类为及时或延迟随访。该提案建立在这项工作的基础上，通过测试候选人可操作的基于系统的沟通和护理协调战略与妇女和转诊医生。我们的研究包括以下具体目标：目标1。利用与弱势妇女的经验访谈，从我们的放射设施数据中测试有待改进的候选领域，并在异常乳房X光检查结果后获得额外的沟通和协调护理经验，感知系统促进者和及时随访的障碍，以及系统改进的具体建议，以促进及时随访。 目标2. a）利用对转诊医生进行的关于异常乳房X线照片随访经验的调查，从我们的放射学设施和Aim 1数据中测试待改进的候选区域;并且，为了确定那些最有可能进行干预的具体因素，调查B）医生对妇女的系统改进建议的可接受性和可行性，c）设施特征与医生关于设施在通信、访问和护理协调方面的性能报告的关联。

项目成果

Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems.

组织沟通因素和异常乳房X光检查随访：对三个医疗系统的不同种族女性的定性研究。

• DOI: 10.1007/s11606-020-05972-2
• 发表时间: 2020
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Kenny,JazmineD;Karliner,LeahS;Kerlikowske,Karla;Kaplan,CeliaP;Fernandez-Lamothe,Ana;Burke,NancyJ
• 通讯作者: Burke,NancyJ