Breast Cancer Screening and Follow-up in a PBRN: The Ma*

描述（由申请人提供）：亚利桑那大学，Sarver心脏中心卫生保健组织在改善乳腺癌筛查和随访过程中发挥着核心作用。对于在医疗系统内接受定期护理的患者，次优乳房x光检查率代表了护理交付的重大系统级失败。因此，克服筛查成功和有效随访障碍的研究工作必须从仅关注患者或医生转向将卫生系统内的护理提供过程包括在内。由于初级保健提供者（PCP）是实践网络中的关键决策者，我们假设基于与特定PCP的联系对患者进行正确分类将创建一种有效分配资源和干预措施以改变护理的机制。对于与PCP联系密切的患者，可以通过医生集中干预以提高乳房x光检查的筛查率，而对于接受系统内护理（通常是间歇性的）但与PCP没有密切联系的患者，可以通过实践经理指导干预。我们建议将为患者确定合适的提供者与临床健康信息系统的使用紧密结合起来，该系统将信息与行动联系起来，并且可以轻松地独立于诊所访问来增强初级保健癌症筛查。我们将实施一个基于信息学的人口管理工具，供pcp或实践管理人员在我们基于实践的研究网络（PBRN）的对照试验中使用。具体目标1：根据患者-PCP连锁状态对MGPC-PBRN内的所有患者进行分类，并描述与PCP有密切联系的患者的特征（“PCP忠诚”）或非PCP忠诚（“实践忠诚”）。具体目标2：开发和实施一种新的乳腺癌筛查干预项目，称为乳房x线摄影快速通道，以促进pcp（针对忠于pcp的患者）或执业经理（针对忠于执业的患者）使用的乳房x线照片的订购和跟踪。具体目标3：在MGPC-PBRN中进行乳房x线造影快速通道项目的组随机试验，以提高对pcp忠诚和对practice忠诚的合格乳腺癌筛查逾期患者的乳房x线造影筛查率。这项研究与全国卫生信息技术能力的现代化和提高有关。我们将创建一个流程来跟踪我们的PBRN内的所有患者，并减少目前订购和跟踪异常乳房x光检查结果的障碍。

DESCRIPTION (PROVIDED BY APPLICANT): University of Arizona, Sarver Heart Center Health care organizations play a central role in improving the process of breast cancer screening and follow-up. For patients receiving regular care within a medical system, sub-optimal mammography screening rates represent a significant system-level failure in care delivery. Research efforts to overcome barriers to screening success and effective follow-up must therefore move from an exclusively patient or physician focus to include the process of care delivery within health systems. Because primary care providers (PCPs) are the key decision makers in a practice network, we hypothesize that correctly classifying patients based on linkage to a specific PCP will create a mechanism to efficiently allocate resources and interventions to change care. For patients with a close PCP linkage, interventions to improve mammography screening rates can be focused through the physician, whereas for patients who receive care (often episodic) from within the system but without close linkage to a PCP, interventions can be directed through a practice manager. We propose to closely couple identifying the right provider for a patient to the use of clinical health informatics systems that link information to action and that can be easily used independent of clinic visits to enhance primary care cancer screening. We will implement an informatics-based population management tool for use by PCPs or practice managers in a controlled trial within our Practice-Based Research Network (PBRN). Specific Aim 1: To classify all patients within the MGPC-PBRN according to patient-PCP linkage status and to describe the characteristics of patients with close linkage to a PCP ("PCP loyal") or not ("Practice loyal"). Specific Aim 2: To develop and implement a novel breast cancer screening intervention program called Mammography FastTrack to facilitate ordering and tracking of mammograms that can be used by either PCPs (for PCP-loyal patients) or by practice managers (for practice-loyal patients). Specific Aim 3: To perform a group randomized trial of the Mammography FastTrack program within the MGPC-PBRN to increase mammography screening rates in both PCP-loyal and Practice-loyal eligible patients overdue for breast cancer screening. This research is relevant to nationwide efforts to modernize and improve health information technology capabilities. We will create a process to track all patients within our PBRN and to reduce current barriers to ordering and following up of abnormal mammogram results.