IMPROVING QUALITY OF BREAST CANCER CARE IN ELDERLY WOMEN

这项研究的主要目的是评估一项 传播实践指南的创新和可复制的模式 来自美国国立卫生研究院关于治疗糖尿病的共识发展会议 早期乳腺癌。我们将使用随机对照设计在一个 明尼苏达州的自愿医院联盟(N=40)。这个 干预措施将包括：(A)向当地提供技术援助 招募肿瘤学意见领袖，他们将提供演示和 非正式同行协商，(B)传播有吸引力的 图文并茂、简明扼要的做法指南，以及(C)集体表演 当地舆论领袖对医生的反馈。设计和内容 将通过初始数据收集阶段通知此干预 为记录实践不符的程度而进行的 制定指导方针，并找出与不遵守有关的因素。 在此初始阶段，我们将：(1)获取有关范围的基线数据 目前的做法对应于被确认为 在1990年的乳腺癌患者护理指南中有效， 以及早期(1979、1980、1985)承认的治疗方法 指南；(2)确定一)特殊医疗的程度 情况，b)患者偏好，c)缺乏医生知识， 和d)医生意见不一致是不遵守这些规定的原因 指南；以及(3)确定患者、提供者和医院 与护理相关的特征不符合 指导方针。使用从第一阶段获得的信息 我们将研究制定我们的干预和培训内容 意见领袖将在其演讲中使用的材料 以及与供应商的讨论。在实施我们的 干预我们将评估患者是否有比例 接受与指南一致的护理在以下方面更好 干预医院比非干预医院，控制 用于基线性能，并确定传播的成本 程序。

The primary aim of this study is to assess the effectiveness of an innovative and replicable model for disseminating practice guidelines emanating from NIH Consensus Development Conferences on the Treatment of Early Breast Cancer. We will use a randomized controlled design in a voluntary consortium of hospitals (N = 40) in Minnesota. The intervention will consist of (a) technical assistance to locally recruited oncology opinion leaders who will provide presentations and informal peer consultations, (b) dissemination of attractively illustrated and concise practice guidelines, and (c) group performance feedback by local opinion leaders to physicians. The design and content of this intervention will be informed by an initial data collection phase conducted to document the extent to which practice does not correspond with guidelines and to identify factors associated with non-compliance. During this initial phase we will: (1) obtain baseline data on the extent to which current practice corresponds to treatments identified as effective in the 1990 guidelines for care of breast cancer patients as well as to treatments recognized in earlier (1979, 1980, 1985) guidelines; (2) determine the degree to which a) special medical circumstances, b) patient preferences, c) lack of physician knowledge, and d) physician disagreement account for noncompliance with these guidelines; and (3) identify patient, provider, and hospital characteristics associated with care that does not comply with guidelines. Using the information gained from the first phase of the study we will formulate the content of our intervention and training materials which will be used by opinion leaders in their presentations to and discussions with providers. Following the implementation of our intervention we will assess whether the proportion of patients who receive care that corresponds with the guidelines is greater at intervention hospitals than at non-intervention hospitals, controlling for baseline performance, and determine the cost of the dissemination program.