IMPROVING QUALITY OF BREAST CANCER CARE IN ELDERLY WOMEN

本研究的主要目的是评估 传播实践准则的创新和可复制模式 美国国立卫生研究院共识发展会议上的治疗 早期乳腺癌 我们将使用随机对照设计， 明尼苏达州的医院自愿联盟（N = 40）。 的 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，他们将提供演讲， 非正式同行协商，（B）传播有吸引力的 图解和简明的实践指南，以及（c）小组绩效 当地意见领袖向医生提供反馈。 设计和内容 将通过初始数据收集阶段了解这一干预措施 进行记录的程度，实践不符合 并确定与不遵守有关的因素。 在这一初始阶段，我们将：（1）获得有关程度的基线数据 目前的做法对应的治疗确定为 在1990年乳腺癌患者护理指南中， 以及早期（1979年，1980年，1985年） （2）确定a）特殊医疗的程度 环境，B）患者偏好，c）缺乏医师知识， 和d）医生不同意解释不遵守这些 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 指南 利用从第一阶段获得的信息， 我们将制定干预和培训的内容 意见领袖在演讲中使用的材料， 与供应商的讨论。 在实施我们的 我们将评估是否有患者的比例， 接受与指导方针相对应的护理， 干预医院比非干预医院， 基准性能，并确定传播成本 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.