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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

基本信息

批准号：
10565954
负责人：
Nathalie Moise
金额：
$ 50.78万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-02-03 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10565954
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 Older Population Outcome Patient Preferences Patients Population Heterogeneity Process Provider Recommendation Reporting Research Research Design Research Personnel Risk Science Screening for cancer System Testing United States National Institutes of Health United States Preventative Services Task Force Woman Work acceptability and feasibility aged 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 diversity recruit screening guidelines theories tumor

项目摘要

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.

项目总结

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A mixed-methods study of multi-level factors influencing mammography overuse among an older ethnically diverse screening population: implications for de-implementation.

DOI：
10.1186/s43058-021-00217-7
发表时间：
2021-09-26
期刊：
Implementation science communications
影响因子：
0
作者：
Austin JD;Tehranifar P;Rodriguez CB;Brotzman L;Agovino M;Ziazadeh D;Moise N;Shelton RC
通讯作者：
Shelton RC