REDUCING AVOIDABLE MORTALITY FROM BREAST CANCER

这项提议代表了福克斯公司之间的合作效果 大通癌症中心，美国医疗和数学政策 旨在降低乳腺癌死亡率的研究(MPR) 按地理位置和组织定义的43,000人小组 50岁及以上的女性。研究目的是改进 遵守规定的医疗建议；改善 最先进的医疗服务的可用性和质量，确保 护理的连续性，从检测到管理，以及 减少准入门槛。这项研究建立在 美国健康检查基金会，乳房和乳房项目 40岁HMO PA/NJ成员的结直肠癌筛查 敬。我们的目标是创建一个持续的系统来刺激 患者和医生遵守建议的 行为和确保适当的医疗管理 有可疑发现的患者。我们试图减少病人， 医生和卫生系统障碍导致可避免的 死亡率。因为乳房X光检查的经济障碍将是 剔除对于研究参与者，我们可以研究的效果 最大化医生和患者所需的干预措施 合规性。干预措施包括补充战略。 针对女性会员、她们的主治医生和 联合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，最初从 战略的最佳组合，以覆盖最多的女性 成本最低。然后，我们将添加更多、更密集的策略 去接触到更难接触到的女性。被提名的医生 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。干预措施的效果将通过以下方式进行评估 由MPR进行的4次调查的平均数。在每一波，300 医生(150名随机抽取的HMO PA/NJ医生和150名 随机选择的地理对照)和1,000个符合年龄条件的人 妇女将接受采访(500名随机选择的HMO PA/新泽西州 和500个符合年龄的地理控制)。分析技术 将包括Logit和Probit模型以及其他适当的 技巧。已被证明成功的干预措施将是 合并到公认的实践标准中，不会 就像经常发生的那样，在赠款结束时终止。使用一个 在全国范围内拥有100万美国医疗保健会员， 和一种类似于收费医疗的医疗实践， 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.