Advancing Systems Approaches to Personal and Population Breast Cancer Screening

描述（由申请人提供）：拟议的PROSPR中心将专注于开发和评估基于系统的方法，以优化个人和人群的乳腺癌筛查连续体护理，使用健康信息技术（IT）。这种方法是及时的，因为电子健康记录（EHRs）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。我们将在一个由综合临床交付系统组成的区域网络中解决这些问题，以初级保健为基础，通过乳房成像、病理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，由两个核心支持，解决关键优先事项并提高护理质量：目标1：通过使用微系统方法测量和反馈来改善乳腺癌筛查系统，以绘制整个筛查过程，并制定可推广的指标来评估变化，表征过程和筛查结果，并开发和实施仪表板工具来测量和报告这些筛查指标；目标2：通过开发ehr集成的个性化乳腺癌筛查模块，促进妇女及其提供者进行乳腺癌筛查的个性化决策，该模块将为妇女提供量身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。并在一项基于实践的随机对照试验中衡量覆盖范围、有效性、采用和实施情况；目标3：比较已建立的和新兴的乳腺癌筛查模式的护理过程的有效性，通过提供目标1和2的定量和人口估计来促进中心项目的整合，并评估新兴模式（例如，断层合成）的影响。我们的区域合作组织拥有经验丰富的多学科专业知识和在国家乳房筛查联盟中的合作记录，提供有关不同人群、护理环境和项目的数据，旨在提高整个乳房护理连续体的护理质量。

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.