Disparities in Abnormal Mammogram Follow-up: Actionable Communication and Care Coordination Strategies

 描述(由申请人提供)：对异常的乳房X光检查结果缺乏及时的跟进可能会导致乳腺癌诊断的延误，进而导致更晚期的癌症。此外，延迟解决(将异常定义为癌症或良性)往往会导致心理痛苦，包括焦虑和抑郁。多项研究发现，解决问题的延迟很常见，少数族裔女性比白人女性更普遍。根据《平价医疗法案》，预计将有更多得不到充分服务的妇女建立初级保健并接受乳房X光检查等预防性服务。随着更多的弱势妇女涌入医疗保健系统，重要的是了解哪些战略有助于特别针对这一群体的及时后续行动。这项建议的总体目标是为制定一项系统干预措施提供信息，以减少弱势妇女异常乳房X光检查随访的及时性差异。这项建议基于旧金山乳房X光照相登记处(SFMR)，该登记处登记了在加利福尼亚州北部两个县的12个参与放射学设施进行乳房X光检查的所有女性。我们的初步工作将SFMR设施归类为及时或延迟的后续行动。这项建议是在这项工作的基础上，通过测试候选人与妇女和转介医生的基于系统的沟通和护理协调战略来实现的。我们的调查包括以下具体目标：目标1.通过采访弱势女性了解她们的经验，测试我们放射设施数据中有待改进的候选领域，并获得在异常乳房X光检查结果后的沟通和护理协调方面的更多经验，感知的系统促进者和及时跟进的障碍，以及为促进及时跟进而对系统改进提出的具体建议。目标2.利用对推荐医生关于异常乳房X光检查后续经验的调查，测试我们的放射学设施和目标1数据的候选改进领域；以及，为了确定最有可能进行干预的特定因素，调查b)医生对妇女系统改进建议的可接受性和可行性，以及c)设施特征与医生对设施在通信、访问和护理协调方面的性能报告的关联。

 DESCRIPTION (provided by applicant): Lack of timely follow-up of an abnormal mammogram result can lead to a delay in breast cancer diagnosis, and in turn a more advanced cancer. Moreover, delays in resolution (defining the abnormality as either cancer or benign) often cause psychological distress, including anxiety and depression. Multiple studies have found delays in resolution to be common, and more prevalent for minority than for white women. Under the Affordable Care Act more underserved women are expected to establish primary care and receive preventive services such as mammograms. With this influx of more vulnerable women into the healthcare system, it is important to understand what strategies contribute to timely follow-up specifically for this population. The overarching goal of this proposal is to inform the development of a system intervention to decrease disparities in timeliness of abnormal mammogram follow-up for vulnerable women. This proposal is based in the San Francisco Mammography Registry (SFMR), a registry of all women having mammograms at twelve participating radiology facilities in two Northern California counties. Our preliminary work has categorized SFMR facilities as having either timely or delayed follow-up. This proposal builds upon that work by testing candidate actionable systems-based communication and care coordination strategies with women and referring physicians. Our investigation encompasses the following specific aims: Aim 1. Test candidate areas for improvement from our radiology facility data utilizing interviews with vulnerable women about their experiences, and elicit additional experiences with communication and coordination of care after an abnormal mammogram result, perceived system facilitators and barriers to timely follow-up, and specific recommendations for system improvements to facilitate timely follow-up. Aim 2. To a) test candidate areas for improvement from our radiology facility and Aim 1 data, utilizing a survey of referring physicians about their experiences with follow-up of abnormal mammograms; and, in order to identify those specific factors with the most potential for intervention, investigate b) physician perceived acceptability and feasibility of the women's recommendations for system improvements and, c) the association of facility characteristics with physician report of facility performance on communication, access and care coordination.