Improving Breast Cancer Screening Systems through Measurement 8 Feedback

数十年的乳腺癌筛查研究表明，乳腺癌死亡率降低了20 - 30%， 导致了美国最成功的公共卫生努力之一，每年有超过3300万妇女参加 进行乳房X光检查。尽管有大量的研究和医疗服务的努力， 尽管已经进入乳腺癌筛查，但优化仍然受到以下关键问题的阻碍： 持续的高死亡率和晚期乳腺癌; B）证明了与以下因素相关的危害 乳腺癌筛查; c）具体指南的模糊性; d）新技术的出现。这些 这些问题已经并将继续通过随机对照试验（RCT）得到解决， 对个人的观察性研究。然而，乳腺癌筛查发生在复杂的系统中， 医疗保健服务，包括个人、提供者、设施、组织和社区。目标 只有通过研究乳腺癌， 在一个涵盖个人、提供者和实践层面的框架内进行癌症筛查 因素先前工作的一个缺点是相对缺乏对决定性因素的系统因素的检查， 护理过程和最终筛查结果。最近的医疗保健改革举措强调， 预防性护理、家庭医疗模式、问责制和信息系统的使用，所有这些都在发挥作用， 在系统层面。经过至少二十年的乳腺癌筛查研究， 筛选过程，因为它发挥了系统内是必要的，以进一步提高筛选的有效性， 并为女性个体和人群优化它。该项目将提供一个系统的方法， 整个筛查过程，并将把卫生信息技术（IT）纳入改进战略， 提高质量，最终提高妇女的成果。我们的主要目标是改善乳腺癌筛查 系统通过测量和反馈，通过以下具体目标：（1）使用微系统 方法，映射整个乳腺癌筛查过程中的异构卫生保健提供系统， 为供应商和实践制定可推广的过程指标度量标准，并评估 健康信息技术环境;（2）描述与以下方面相关的过程和筛选结果 妇女，提供者和实践层面的相关性;（3）开发和实施提供者和实践层面的 仪表板工具，用于测量和报告乳腺癌筛查流程的指标。这项研究将 为乳腺癌筛查系统的总体工作方式提供关键证据，哪些系统因素是 并将开始为改进分娩过程提供工具 以实现对妇女个人和整个群体的最大利益和最小伤害。

Decades of breast cancer screening research demonstrating a 20-30% reduction in breast cancer mortality, has led to one of the most successful public health efforts in the U.S. with over 33 million women a year in this country undergo screening mammography. In spite of the tremendous research and health care delivery efforts that have gone into breast cancer screening, optimization remains hampered by the key issues including: a) continued excess mortality and advanced stage of breast cancer; b) demonstrated harms associated with breast cancer screening; c) ambiguity over specific guidelines; d) emergence of new technologies. These issues have been, and continue to be addressed through randomized controlled trials (RCTs) and observational studies of individuals. However, breast cancer screening occurs within complex systems of health care delivery, encompassing individuals, providers, facilities, organizations, and communities. The goal of screening 'the right women with the right test at the right time' is likely to only be achieved by studying breast cancer screening processes within a framework that encompasses individual, provider, and practice-level factors. A shortcoming of prior work has been a relative lack of examining system factors that determine processes of care and ultimately screening outcomes. Recent health care reform initiatives emphasize preventive care, a medical home model, accountability, and use of information systems ¿ all of which operate at a systems-level. After at least two decades of breast cancer screening research, a shift to examining the screening process as it plays out within systems is necessary to further improve the effectiveness of screening, and to optimize it for individual women and for populations. This project will provide a systems approach to the entire screening process and will integrate health information technology (IT) into improvement strategies to advance quality, and ultimately women's outcomes. Our main objective is to improve breast cancer screening systems through measurement and feedback through the following specific aims: (1) use a microsystems approach, map the entire breast screening process within heterogeneous health care delivery systems, develop generalizable metrics of process indicators for providers and practices, and assess process change in a health information technology environment; (2) characterize process and screening outcomes in relation to woman-, provider-, and practice-level correlates; and (3) develop and implement a provider and practice-level dashboard tool to measure and report metrics for breast cancer screening processes. This research will provide critical evidence of how breast cancer screening systems work overall, which system factors are salient, and for which subgroups of women, and will begin to contribute tools for improving delivery processes in order to achieve the greatest benefit with the least harm for women individually and from a population level.