Implementing a Tracking & Feedback Registry to Allay Cancer Therapy Disparities

描述（由申请人提供）：乳腺癌是女性癌症死亡的第二大常见原因。黑人妇女比白色妇女患乳腺癌的可能性小，但她们更有可能死于这种疾病。这种生存差异可能是由于未充分使用已证明可提高生存率的辅助治疗。乳腺癌治疗通常需要外科医生、病理学家、初级保健医生、医学和放射肿瘤学家之间的协调。在纽约市，接受护理和手术治疗乳腺癌的黑人和西班牙裔妇女的辅助治疗使用不足的可能性是白人的两倍。令人不安的是，这些未充分使用的病例中有1/3是外科医生建议治疗的事件，患者没有拒绝，但护理没有随之而来。在这种情况下，使用不足是由于系统故障，而不是由于特定的提供者或患者因素。在这项拟议的随机对照试验中，我们的目标是测试跟踪和反馈（T&F）登记创新的有效性，以提高完成肿瘤咨询的比率，并减少所需辅助治疗的使用不足和接受这些治疗的种族差异。我们还旨在通过评估该创新的实施效果，评估在这些高风险医院实施T&F登记的可行性。我们招募了11家为大部分少数民族乳腺癌妇女提供服务的医院。我们将随机选择医院，目标是招募540名新发乳腺癌患者，每个干预组270名。我们选择这些“高风险”医院，因为它们主要服务于少数人群，这些医院因使用不足而导致的系统故障率较高，特别是我们跟踪和反馈登记处针对的使用不足类型。

DESCRIPTION (provided by applicant): Breast cancer is the second most common cause of cancer death in women. Black women are less likely than white women to develop breast cancer but, they are more likely to die of the disease. Some of this survival discrepancy is likely due to underuse of adjuvant therapies proven to increase survival. Breast cancer treatment often requires coordination among surgeons, pathologists, primary care physicians, medical and radiation oncologists. In NYC, black and Hispanic women who accessed care and underwent surgical treatment of their breast cancer were twice as likely as whites to experience underuse of adjuvant treatment. Disturbingly, 1/3 of these underuse cases were episodes in which the surgeon recommended treatment, the patient did not refuse and yet, care did not ensue. Underuse in such circumstances is attributable to system failures than to specific provider or patient factors. In this proposed randomized controlled trial, we aim to test the effectiveness of a Tracking and Feedback (T&F) registry innovation to increase rates of completed oncology consultation and reduce both underuse of needed adjuvant therapy and racial disparities in receipt of these treatments. We also aim to assess the feasibility of implementing a T&F Registry in these high-risk hospitals by evaluating implementation effectiveness for that innovation. We have recruited 11 hospitals that serve large proportions of minority women with breast cancer. We will randomize hospitals and aim to recruit 540 women with a new breast cancer, 270 per intervention arm. We choose these "high risk" hospitals because they serve predominantly minority populations, and such hospitals have higher rates of the system failure cause of underuse, and particularly, the type of underuse targeted by our Tracking and Feedback Registry.