Health System Factors and Patient Outcomes in Breast Cancer

描述（由申请人提供）：来自癌症社区的利益相关者强调，需要进行与输送系统结构和过程相关的研究，以告知提高护理质量的举措。尽管对信息的需求不断增长，但关于癌症护理提供的实践特征和过程的变化如何影响相关患者结果的严格研究很少。拟定的竞争性继续研究的具体目的是：1）通过自我管理的邮寄调查（或电话调查选项），收集来自底特律SEER登记研究的1800例近期诊断为乳腺癌的女性患者及其主治外科医生和肿瘤学家的基于人群的样本信息。患者调查信息将通过SEER登记研究的社会人口统计学和临床数据进行扩充; 2）描述我们样本中临床医生报告的关键输送系统过程测量以及医生和实践特征测量的变化。交付系统过程测量评估临床信息的可用性、提供者团队设计、患者决策和护理支持以及实践管理支持。医生特征包括年龄、性别、种族、执业年限和乳腺癌相关实践量。实践特征包括支付者组合，大学附属关系，教学计划状态，实践规模，癌症计划状态和实践资源; 3）检查三个患者结果与交付系统过程测量分数的关联。患者结局包括：1）对决策和护理过程评价的满意度; 2）手术和非手术治疗的利用率; 3）健康相关的生活质量; 4）检查患者结局与种族或社会人口因素的关联是否在不同的输送系统过程测量评分中存在差异。拟议研究的结果将为提高社区乳腺癌妇女护理质量的举措和干预措施提供信息。

DESCRIPTION (provided by applicant): Stakeholders from across the cancer community have stressed the need for research related to delivery system structure and processes to inform initiatives to improve the quality of care. Despite this growing demand for information, little rigorous research exists about how variations in practice characteristics and processes of cancer care delivery affect relevant patient outcomes. The specific aims of the proposed competing continuation study are: 1) To collect information on a population- based sample of 1800 female patients recently diagnosed with breast cancer derived from the Detroit SEER registry and their attending surgeons and oncologists via a self-administered mailed survey (or telephone survey option). Patient survey information will be augmented by sociodemographic and clinical data from the SEER registry; 2) To describe the variations reported by the clinicians in our sample in key delivery system process measures as well as in measures of physician and practice characteristics. The delivery system process measures assess availability of clinical information, provider team design, patient decision and care support, and practice management support. Physician characteristics include age, gender, race, number of years in practice, and volume of breast cancer-related practice. Practice characteristics include payer mix, university affiliation, teaching program status, practice size, cancer program status, and practice resources; 3) To examine the association of three patient outcomes with delivery system process measure scores. Patient outcomes include: 1) satisfaction with decision-making and evaluation of care processes; 2) the utilization of surgical and non-surgical treatments; and 3) health-related quality of life; and 4) To examine whether the association of patient outcomes with race or sociodemographic factors varies across delivery system process measure scores. The results from the proposed study will inform initiatives and interventions to improve the quality of care for women with breast cancer in the community.