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

摘要 50多年来，美国一直试图通过筛查降低宫颈癌死亡率;然而， 差距依然存在。引入致癌的人乳头瘤病毒（HPV）为基础的测试和HPV疫苗， 扩大了宫颈癌预防战略，改变了筛查和管理指南。作为 随着技术、指南和政策的变化，我们对癌症筛查的多层次优化 过程在不同的设置和人群（METRICS）PROSPR II研究中心将阐明多层次 阻碍或促进宫颈癌筛查过程和减少弱势群体之间差距的因素 人口。METRICS联合了三个PROSPR I研究中心，具有提供 验证了约120万筛查和未筛查女性的合并队列数据。我们的社区 设置代表3种护理提供模式-安全网系统、管理式护理系统和初级护理 德克萨斯州、华盛顿和马萨诸塞州的供应商网络。我们将收集、协调和记录> 10年高质量，全面的宫颈癌筛查过程数据在患者，供应商， 临床和系统级，使用丰富的电子临床信息系统和新的数据源。 我们的合并群体在社会经济和地理上多样化，包括弱势群体 例如感染艾滋病毒和没有保险的妇女。我们的三个相互关联的观测项目是 旨在了解宫颈癌筛查是如何在我们的一系列交付模式中交付的， 以及如何优化筛选过程以减少差异。创新的地理空间和贝叶斯统计 项目1中的方法将更好地阐明筛选过程中发生的变化水平。项目2将 调查多层次的计划和政策如何影响对平均风险妇女指导方针的遵守。 项目3将为风险改变的女性提供精确筛查信息。根据我们的观察结果， 在第4-5年，我们将设计和实施试点干预措施，利用信息技术支持的工具来解决关键故障 在筛选过程中，减少差异。我们的跨学科团队有流行病学家，主要和 专业护理医生和干预、实施和医疗保健提供专家。我们准备 有效地评估整个宫颈癌筛查过程，并提供专业知识，领导和资源 跨机构的PROSPR II合作。我们的核心和研究项目将实现我们的目标， 通过以下方式促进对社区环境中筛查实践的理解：（1）分析 多层次的观察数据，从我们的异质性设置与不同的人口，（2）发展和 测试有效的干预措施，以优化筛选过程，以及（3）我们的新方法的应用 其他器官的癌症筛查过程的观察项目和质量指标。基于我们 在PROSPR I中领导和合作的成功经验，我们精心组织了我们的四个核心， 能够快速有效地开展研究活动并为trans-PROSPR II活动做出贡献。

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.