De-implementation of Mammography Overuse in Older Racially and Ethnically Diverse Women

消除不同种族和民族的老年女性过度使用乳房X光检查

• 批准号: 10097696
• 负责人: Nathalie Moise
• 金额: $ 54.1万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-03 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10097696
• 关键词: Address; Administrator; Adoption; Advocate; Age; American College of Physicians; Anxiety; Area; Breast Cancer Detection; Breast Cancer Risk Factor; Caring; Clinic; Cluster randomized trial; Communities; Complex; Data; Data Collection; Deimplementation; Development; Diagnosis; Diagnostic tests; Effectiveness; Elderly; Equilibrium; Evidence based practice; Excision; Family member; Frequencies; Future; Goals; Guidelines; Habits; Health; Healthcare Systems; Hybrids; Knowledge; Learning; Letters; Life Expectancy; Mammary Neoplasms; Mammographic screening; Mammography; Methodology; Methods; Modeling; Morbidity - disease rate; New York City; Outcome; Patient Preferences; Patients; Population Heterogeneity; Process; Provider; Reporting; Research; Research Design; Research Personnel; Risk; Science; Screening for cancer; System; Testing; United States National Institutes of Health; Woman; Work; acceptability and feasibility; aged; base; care delivery; crowdsourcing; design; ethnic diversity; experimental study; follow-up; health care delivery; implementation framework; implementation science; implementation strategy; improved; innovation; malignant breast neoplasm; mortality; older patient; older women; overtreatment; preference; racial and ethnic; racial diversity; recruit; screening guidelines; theories; tumor

PROJECT SUMMARY De-implementation is recognized as a critical but understudied area within implementation science (IS). Research is needed to determine the optimal methods and approaches for identifying, selecting, and tailoring de-implementation strategies. De-implementation of routine cancer screening in older adults, such as mammography screening for breast cancer, offers excellent opportunities for both advancing the science of de- implementation and improving care delivery and health outcomes in older adults. While national guidelines do not support routine mammography in older women and recommend consideration of morbidities, life expectancy and patients’ informed preferences, ~56% of women ≥75 years report receiving mammography, including 50% of women with life expectancy <10 years. Our preliminary research identified multi-level barriers and facilitators to de-implementation of mammography overuse among older women at the organizational (e.g. system alerts, patient reminder letters), provider/clinic (e.g., knowledge, clinic norms), and patient (e.g. habit, knowledge) levels. Informed by the Knowledge-to-Action Model, we propose a study for de-implementation of mammography overuse in older women (i.e., reducing the frequency or cessation of mammography) in older women across a large healthcare system serving a racially/ethnically diverse population in New York City. In Aim 1, we will identify a range of de-implementation strategies at the patient, provider, and organizational levels for reducing mammography overuse in women ages ≥75 years. We will use a crowdsourcing method, successfully applied in an emerging participatory IS approach (innovation tournament) to generate rapid data collection from diverse stakeholders (80-100 patients/family members, 80-100 providers/administrators from the community and multiple healthcare systems) on factors that influence de-implementation. Combining this data with our rich qualitative preliminary data, and principles from Dual Process Theory, we will develop distinct de-implementation strategies for refinement in Aim 2. In Aim 2, we will prioritize and tailor de-implementation strategies at patient, provider/clinic, and organizational levels. We will recruit 12-15 experts to prioritize strategies based on feasibility and acceptability, and propose key attributes (e.g., duration, frequency, content) for each strategy, and employ discrete choice experiment to elicit patient (n=75-100) and provider (n=75-100) preferences for modifiable attributes of each prioritized strategy. In Aim 3, we will evaluate the feasibility, acceptability, and use of the tailored de-implementation strategies in a pilot cluster randomized trial (8 clinics). Using a sequential mixed-methods design, we will assess use of strategies, de-adoption outcomes (e.g. reduction of mammography overuse), and theoretical mechanisms of strategies at the patient, provider, and organizational levels. Data will establish feasibility and provide preliminary data for effectiveness of strategies to be tested in future Hybrid 2 trial, and lay the groundwork for advancing de-implementation frameworks and methodological approaches for selecting de-implementation strategies to reduce the use of low-value care.

项目摘要 取消执行被认为是执行科学中一个关键但研究不足的领域。 需要进行研究以确定识别、选择和剪裁的最佳方法和途径 执行战略。在老年人中取消常规癌症筛查，例如 乳腺癌的乳房X光检查筛查，为促进乳腺癌的科学发展提供了极好的机会， 实施和改善老年人的护理服务和健康成果。虽然国家指导方针 不支持老年妇女常规乳房X线检查，并建议考虑发病率，生活 预期和患者知情偏好，约56%的≥75岁女性报告接受乳房X线检查， 包括50%预期寿命小于10年的妇女。我们的初步研究发现了多层次的障碍 和促进者，以取消实施乳房X光检查过度使用的老年妇女在组织（例如， 系统警报，患者提醒信），提供者/诊所（例如，知识，临床规范），和患者（例如习惯， 知识）水平。根据知识-行动模式，我们提出了一项研究， 在老年妇女中过度使用乳房X光检查（即，减少或停止乳房X光检查） 在为纽约市不同种族/民族的人口服务的大型医疗保健系统中，在 目标1，我们将在患者、提供者和组织中确定一系列去实现策略 降低年龄≥75岁女性乳腺X线摄影过度使用的水平。我们将采用众包的方法， 成功应用于新兴的参与式信息系统方法（创新锦标赛），以生成快速数据 从不同的利益相关者收集（80-100名患者/家庭成员，80-100名提供者/管理员， 社区和多个保健系统）对影响取消执行的因素的研究。组合该 数据与我们丰富的定性初步数据，并从双过程理论的原则，我们将开发不同的 目标2中的细化去实现策略。在目标2中，我们将优先考虑并量身定制取消执行 患者、提供者/诊所和组织层面的战略。我们将招募12-15名专家， 基于可行性和可接受性的策略，并提出关键属性（例如，持续时间、频率、内容） 对于每种策略，并采用离散选择实验，以引出患者（n=75-100）和提供者（n=75-100） 每个优先化策略的可修改属性的偏好。在目标3中，我们将评估可行性， 可接受性，并在试点集群随机试验（8个诊所）中使用量身定制的去执行策略。 使用序贯混合方法设计，我们将评估策略的使用，取消采用的结果（例如， 减少乳房X线摄影过度使用），以及患者、提供者和 组织层面。数据将确定可行性，并为战略的有效性提供初步数据 将在未来的混合2试验中进行测试，并为推进取消执行框架奠定基础， 选择取消执行战略的方法，以减少使用低价值护理。