Advancing Systems Approaches to Personal and Population Breast Cancer Screening

描述(由申请人提供)：拟建的PROSPR中心将专注于开发和评估基于系统的方法，以利用健康信息技术(IT)在乳腺癌筛查连续过程中为个人和人群优化护理。这种方法是及时的，因为电子健康记录(EHR)的广泛部署和“有意义的使用”为开发基于系统的解决方案提供了基础设施、机会和激励。我们将在一个区域网络中解决这些问题，该网络由集成的临床交付系统组成，以初级保健为基础，通过乳房成像、病理学和初步癌症治疗获得全面的数据。我们的三个总体项目/具体目标得到两个核心的支持，解决了关键的优先事项，并提高了护理质量：目标1：通过使用微系统方法的测量和反馈来改进乳腺癌筛查系统，以绘制整个筛查过程的图，并制定通用指标来评估变化、表征过程和筛查结果，以及开发和实施仪表板工具来衡量和报告这些筛查指标；目标2：通过开发集成了电子病历的个性化乳腺癌筛查模块来促进妇女及其提供者的乳腺癌筛查个性化决策，该模块将为妇女生成定制的风险评估和筛查建议，并为其提供者提供量身定制的决策支持。并在一项以实践为基础的随机对照试验中衡量覆盖范围、有效性、采用率和实施情况；目标3：比较现有的和新出现的乳腺癌筛查模式在各个系统中的护理流程的有效性，通过提供目标1和2的量化和人口估计来促进该中心项目的整合，并评估新出现的模式(例如断层扫描合成)的影响。我们的地区性协作具有经验丰富的多学科专业知识，以及在全国乳房筛查联盟中的合作记录，提供有关不同人群和护理环境的数据，以及旨在提高整个乳房护理连续体系的护理质量的项目。

DESCRIPTION (provided by applicant): The proposed PROSPR Center will focus on developing and evaluating systems-based approaches to optimize care across the breast cancer screening continuum, for both individuals and populations, using health information technology (IT). This approach is timely as the widespread deployment and "meaningful use" of electronic health records (EHRs) provides infrastructure, opportunity, and incentive to develop systems-based solutions. We will address these issues within a regional network comprised of integrated clinical delivery systems, based in primary care with comprehensive data capture through breast imaging, pathology, and initial cancer treatment. Our three over-arching Projects/Specific Aims, supported by two cores, address key priorities and promote the quality of care: Aim 1: To improve breast cancer screening systems through measurement and feedback using a micro-systems approach to map the entire screening process and develop generalizable metrics to assess change, characterize process and screening outcomes, and develop and implement dashboard tools to measure and report these screening metrics; Aim 2: To promote personalized decisions for breast cancer screening for women and their providers by developing an EHR-integrated, personalized breast cancer screening module that will generate tailored risk assessment and screening recommendations for women and tailored decision support for their providers. and measure the reach, effectiveness, adoption and implementation in a practice-based randomized controlled trial; Aim 3: To compare the effectiveness of care processes across systems for established and emerging breast cancer screening modalities, promoting integration across the Center's projects by providing both quantitative and population estimates for Aims 1 and 2, and to assess the impact of emerging modalities (e.g., tomosynthesis). Our regional collaborative, with seasoned, multi-disciplinary expertise and a track record of collaboration in a national breast screening consortium, offers data on diverse populations and care settings and projects that are designed to improve the quality of care across the breast care continuum.