REDUCING AVOIDABLE MORTALITY FROM BREAST CANCER

这一提议代表了福克斯与 Chase癌症中心，美国医疗保健和数学政策 研究（MPR），以降低乳腺癌的死亡率， 按地域和组织划分的43 000人群体 50岁及以上的妇女。 本研究的目的是提高 遵守规定的医疗建议;改善 提供最先进的保健服务，保证 护理的连续性，从检测到管理，以及 减少准入障碍。 该研究建立在 美国健康基金会，一个乳房和 为40岁的HMO PA/NJ成员进行结肠直肠筛查 到64。 我们的目标是建立一个持续的系统， 患者和医生对建议的 行为和确保适当的医疗管理 有可疑发现的病人 我们试图减少病人， 医生和卫生系统的障碍，导致可避免的 mortality. 由于乳房X光检查的经济障碍将是 对于研究参与者，我们可以研究 需要采取干预措施， 合规 干预措施包括补充战略 针对女性成员、她们的主治医生和 相关的放射科医生和医疗保健系统本身。 我们 将使用分步护理方法，首先从 战略的最佳组合， 成本最低。 然后，我们将添加额外的，更密集的策略 去接触那些更难接触到的女性 推荐医生 干预措施包括自学手册、讲习班、 全面的提醒系统，将作为桥梁 在病人和医生的干预和同行领导之间 系统 干预措施的有效性将通过以下方式进行评价： 通过MPR进行的4次调查。 每波300人 医生（150名随机选择的HMO PA/新泽西州医生和150名 随机选择的地理对照）和1，000名年龄合格的 妇女将接受采访（500名随机选择的HMO PA/NJ 和500名年龄合格的地理对照）。 分析技术 将包括logit和probit模型以及其他适当的 技术. 已证明成功的干预措施将 纳入公认的实践标准，不会 就像经常发生的那样，在补助金结束时终止。 与 全国一百万美国医疗保健会员， 和一种类似于按服务收费的医疗做法， 这个项目改变医学实践的潜力是巨大的。

This proposal represents a collaborative effect between Fox Chase Cancer Center, US Healthcare and Mathematic Policy Research (MPR) to reduce mortality from breast cancer in a geographically and organizationally-defined group of 43,000 women 50 years of age and older. The study aims are improve compliance with prescribed medical recommendations; improve availability and quality of state-of-the-art health services, assure continuity of care, from detection through management, and reduce barriers to access. The research builds upon the foundation of US HEALTHCHECK, a program of breast and colorectal screening for members of HMO PA/NJ who are aged 40 to 64. We aim to create an ongoing system for stimulating patient and physician compliance with the recommended behaviors and ensuring the appropriate medical management of patients with suspicious findings. We seek to reduce the patient, physician and health system barriers that result in avoidable mortality. Since the financial barrier to mammorgraphy will be removed for the study participants, we can study the efficacy of interventions needed to maximize physician and patient compliance. The interventions include complementary strategies aimed at women members, their primary physicians and associated radiologist and at the health care system itself. We will use a stepped-care approach, starting initially with the optimal combination of strategies to reach the most women at the least cost. Then, we will add additional, more intensive strategies to reach the more hard-to-reach women. The proposed physician interventions include a self-learning manual, workshops, a comprehensive reminder system that will serve as the bridge between the patient and physician interventions and a peer leader system. The efficacy of the interventions will be evaluated by means of 4 surveys conducted by MPR. In each wave, 300 physicians (150 randomly selected HMO PA/NJ physicians and 150 randomly selected geographical controls) and 1,000 age-eligible women will be interviewed (500 randomly selected HMO PA/NJ and 500 age-eligible geographic controls). Analytic techniques will include logit and probit models and other appropriate techniques. Interventions with proven success will be incorporated into the accepted standard of practice and will not terminate, as so often happens, at the end of the grant. With a nationwide membership of one million US Healthcare members, and a medical practice similar to fee-for-service medicine, the potential of this project to alter the practice of medicine is great.