Multilevel Model of Breast Cancer Follow-up Care

描述(由申请人提供)：除非使用适当的诊断测试来明确诊断任何潜在的癌症，否则乳腺癌筛查是无效的。尽管已经制定了指南来最大限度地提高诊断准确性，但在一项初步研究中，我们发现，在筛查结果异常的爱荷华州低收入女性中，有14%的人进行了基于这些指南的诊断随访，这是不够的。 关于乳腺癌护理质量的研究通常只包括患者因素，而忽略了女性居住的社区也可能影响健康状况的事实。社区贫困与乳腺癌的发病率、存活率和行为有独立关联，但目前尚不清楚，来自社会和经济贫困程度较高地区的低收入女性是否不太可能获得足够的诊断随访，以及造成这种差异的潜在原因是什么。拟议项目的目标是分析2800名乳腺癌筛查结果异常的低收入密苏里州妇女的现有数据，并收集近300名密苏里州低收入妇女的原始数据，以测试四种不同的途径，通过这些途径，来自贫困程度较高地区的低收入妇女在未来的R01项目中不太可能获得足够的诊断随访。这四条途径是：一)对包括保健在内的社区基础设施投资不足；二)破坏社会结构/凝聚力；三)居住在这些地区的妇女的个人特征是关键，而不是她们所在地区的特点；四)剥夺直接影响诊断后续行动的充分性。在拟议的研究中，我们将能够在多水平概念模型中部分测试路径I、III和IV，尽管不是这些路径的所有变量都将在现有的数据源中可用。将测试数据收集工具，并将在发展研究中评估招募和参与方面的潜在偏见。这些主要数据将构成途径II(社会凝聚力)的基础，将在未来的R01赠款中与其他三条途径同时进行测试，以审查为什么来自社会和经济贫困程度较高地区的妇女不太可能得到适当的诊断后续治疗。

DESCRIPTION (provided by applicant): Screening for breast cancer is not effective unless the appropriate diagnostic tests are used to definitively diagnose any potential cancer. Although guidelines have been developed to maximize diagnostic accuracy, in a preliminary study we found that 14 percent of low-income Iowa women with abnormal screening results had diagnostic follow-up that was inadequate based on these guidelines. Studies about the quality of breast cancer care have typically included only patient factors and have ignored the fact that communities in which women reside may also shape health status. Community deprivation is independently associated with breast cancer incidence and survival and with behaviors, but it is unclear if low-income women from areas with higher social and economic deprivation are less likely to receive adequate diagnostic follow-up and what the potential reasons are for such disparities. The goal of the proposed project is to analyze existing data of 2,800 low-income Missouri women with abnormal breast cancer screening results and to collect primary data of nearly 300 low-income Missouri women in order to test four different pathways by which low-income women from areas with higher deprivation are less likely to receive adequate diagnostic follow-up in a future R01 project. The four pathways are: I) under investment in community infrastructure, including health care; II) disruption of the social fabric/cohesion; III) individual characteristics of women who reside in these areas are key rather than the characteristics of the areas in which they live; and IV) deprivation directly influences adequacy of diagnostic follow-up. In the proposed study we will be able to partly test pathways I, III, and IV in a multilevel conceptual model, although not all variables for these pathways will be available in the existing data sources. Data collection instruments will be tested and potential biases in recruitment and participation will be assessed in a developmental study. These primary data will form the basis for pathway II (social cohesion), which will be tested simultaneously with the other three pathways in a future R01 grant to examine reasons why women from areas with higher social and economic deprivation are less likely to receive adequate diagnostic follow-up.