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Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations (METRICS)

不同环境下宫颈癌筛查流程的多层次优化

基本信息

批准号：
9428996
负责人：
JENNIFER S HAAS
金额：
$ 324.31万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-10 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9428996
关键词：
Address Adherence Affect Bayesian Method Cancer Control Research Caring Cervical Cervical Cancer Screening Cessation of life Clinic Clinical Collaborations Colorectal Cancer Colposcopy Community Healthcare Complex County Data Data Sources Detection Development Diagnostic Effectiveness Epidemiologist Evaluation Exhibits Failure Geography Goals Guidelines HIV HIV Infections Harm Reduction Health Health system Healthcare Healthcare Systems High-Risk Cancer Hospitals Human Papilloma Virus Vaccine Human Papillomavirus Information Systems Intervention Knowledge Laboratories Lead Leadership Lesion Low income Malignant neoplasm of cervix uteri Managed Care Massachusetts Measures Methods Modeling Observational Study Oncogenic Organ Outcome Patients Physicians Policies Population Population Heterogeneity Premalignant Prevention Prevention strategy Process Provider Research Research Activity Research Personnel Research Project Grants Resources Risk Risk Assessment Scientist Screening for cancer Service delivery model Subgroup System Technology Testing Texas Therapeutic immunosuppression Time Uninsured Variant Vulnerable Populations Washington Woman base cancer invasiveness cancer type care providers care systems cervical cancer prevention clinical practice cohort community setting design disparity reduction ethnic minority population experience follow-up health care delivery health care settings improved innovation lung cancer screening medical specialties multidisciplinary multilevel analysis new technology novel patient population payment personalized screening programs provider networks racial and ethnic safety net screening socioeconomics tool uptake

项目摘要

ABSTRACT For more than 5 decades, the US has sought to lower cervical cancer deaths through screening; however, disparities remain. Introduction of oncogenic human papillomavirus (HPV)-based tests and HPV vaccines have expanded cervical cancer prevention strategies and changed screening and management guidelines. As technology, guidelines, and policies change, our MultilEvel OpTimization of the CeRvIcal Cancer Screening Process in Diverse Settings & Populations (METRICS) PROSPR II Research Center will elucidate multilevel factors that hamper or facilitate the cervical cancer screening process and reduce disparities in vulnerable populations. METRICS unites three PROSPR I Research Centers with demonstrated capability to provide validated data for a combined cohort of ~1.2 million screened and unscreened women. Our community settings represent 3 care delivery models—safety-net system, managed care system, and primary care provider networks in Texas, Washington, and Massachusetts. We will collect, harmonize, and document > 10 years of high-quality, comprehensive cervical cancer screening process data at the patient, provider, clinic, and system levels using a rich array of electronic clinical information systems and novel data sources. Our combined cohort is socioeconomically and geographically diverse and includes vulnerable groups such as HIV-infected and uninsured women. Our three interconnected observational projects are designed to understand how cervical cancer screening is delivered across our spectrum of delivery models, and how to optimize the screening process to reduce disparities. Innovative geospatial and Bayesian statistical methods in Project 1 will better elucidate at what levels variation in screening process occurs. Project 2 will investigate how multilevel programs and policies influence adherence to guidelines for average-risk women. Project 3 will inform precision screening for women with altered risk. Based on our observational findings, in years 4-5, we will design and implement pilot interventions leveraging IT-enabled tools to address key failures in the screening process and reduce disparities. Our transdisciplinary team has epidemiologists, primary and specialty care physicians, and intervention, implementation, and healthcare delivery experts. We are poised to efficiently evaluate the full cervical cancer screening process and provide expertise, leadership, and resources for cross-organ PROSPR II collaborations. Our cores and research projects will achieve our goals of advancing understanding of screening as practiced in community settings through: (1) analysis of multilevel observational data from our heterogeneous settings with diverse populations, (2) development and testing of impactful interventions to optimize the screening process, and (3) application of our novel observational projects and quality metrics to the cancer screening processes for other organs. Based on our successful experience leading and collaborating in PROSPR I, we thoughtfully organized our four cores to be able to launch research activities and contribute to trans-PROSPR II activities quickly and effectively.

摘要