PRACTICE GUIDELINES: CAN WE EXPLAIN FAILURE TO COMPLY

本申请书是2月1日提交的申请书(ROL HS07019)的修订版 1991年。我们将评估对NIH协商一致会议指导方针的遵守情况 关于早期乳腺癌的前瞻性数据来自于 马萨诸塞州1400名新诊断妇女的代表性样本 疾病。病例将通过医院病理记录和 将收集数据。通过病历回顾、医生问卷、 和病人面谈。我们将确定女性的比例 不能接受符合共识指导方针的护理。收费率 对长期建议的遵从性将与费率进行比较 最近颁布的建议。我们将确定患者的身份(例如 年龄、种族、社会经济地位)、医生(例如年龄、专业、 性别)和医院(如规模、地点、教学状况)因素 与不符合指导方针的护理相关。我们还将 确定特殊医疗情况、患者 偏好、缺乏医生知识以及医生对 准则说明了不遵守准则的原因。结果是 我们的分析将使我们能够提出有针对性的干预措施 提高对指导方针的遵从性。

This application is a revision of one (ROl HS07019) submitted February 1 1991. We will assess compliance with NIH Consensus Conference guidelines on early stage breast cancer employing prospective data from a representative sample of 1400 Massachusetts women with newly diagnosed disease. Cases will be identified through hospital pathology records and data will be collected. through chart review, physician questionnaires, and patient interviews. We will determine the proportion of women who fail to receive care that complies with consensus guidelines. Rates of compliance with longstanding recommendations will be compared with rates for recently promulgated recommendations. We will identify patient (e.g. age, race, socio-economic status), physician (e.g. age, specialty, gender) and hospital (e.g. size, location, teaching status) factors associated with care that does not comply with guidelines. We will also determine the degree to which special medical circumstances, patient preferences, lack of physician knowledge and physician disagreement with guidelines account for non-compliance with guidelines. The results of our analyses will allow us to propose targeted interventions aimed at increasing compliance with guidelines.