Comparative Effectiveness Core

项目总结--比较效益核心 虽然技术进步改善了乳腺癌筛查和监测，但乳腺癌仍然是美国女性癌症死亡的第二大原因，有证据表明，在乳腺癌死亡率方面存在种族和民族差异。关于如何最好地改善与乳腺癌筛查和监测相关的护理，重点是减少这些差异，缺乏证据。乳腺癌监测联盟(BCSC)拥有独特的数据和建立的基础设施，以记录不同社区妇女的乳腺癌筛查和监测实践和表现。达特茅斯学院是BCSC乳腺成像注册网站，是比较有效性(CE)核心的所在地。达特茅斯公司在决策分析建模方法和应用方面拥有广泛的资源和专业知识，包括与NCI资助的癌症干预和监测建模网络(CISNET)建立的合作。此外，达特茅斯大学的研究人员开创了癌症筛查、风险沟通和过度诊断研究的先河，并一直处于领先地位。CE Core将提供决策科学、模拟建模、风险交流和定性研究方面的专业知识，以有效地支持该计划的相对有效性和翻译目标。在下一个供资周期中，CE核心将继续提供比较建模服务，使用三个“信息和通信技术网络”模拟模型，将短期项目成果转化为更长的时间范围。模拟将解决创新的乳腺癌筛查战略的净收益、危害和公平影响，这些战略的目标是基于晚期癌症风险的女性水平的筛查，并将审查旨在与项目1和项目2合作改善筛查使用和性能的设施质量干预措施。此外，将与项目3合作，利用定性研究为项目的创新风险模型的临床应用提供信息，以确定临床采用的障碍和促进者。CE核心的具体目标是：1)提供基本的方法学专业知识和模型资源；2)支持对替代女性水平筛查战略和设施水平质量干预战略的长期比较有效性的评估，以平衡利益、伤害和公平；3)为该计划针对乳房成像的风险模型的开发和临床应用提供信息。由CE Core支持的研究将提供关于最有效和最公平的基于风险的乳腺癌筛查和质量改进战略的信息。此外，CE核心支持的研究结果将促进未来传播和实施侧重于克服基于风险的成像障碍的研究。CE核心内的建模和其他专门服务的集中化将增强所有计划组件之间的交互。

PROJECT SUMMARY – Comparative Effectiveness Core While technological advances have improved breast cancer screening and surveillance, breast cancer remains the second leading cause of cancer death for women in the United States with documented racial and ethnic disparities in breast cancer mortality. Evidence on how best to improve care related to breast cancer screening and surveillance with a focus on reducing these disparities is lacking. The Breast Cancer Surveillance Consortium (BCSC) has unique data and an established infrastructure to document breast cancer screening and surveillance practice and performance among women in diverse community settings. Dartmouth College, where the Comparative Effectiveness (CE) Core is based, is a BCSC breast imaging registry site. Dartmouth has extensive resources and expertise in decision-analytic modeling methods and application, including an established collaboration with the NCI-funded Cancer Intervention and Surveillance modeling Network (CISNET). Furthermore, Dartmouth researchers pioneered and remain leaders in the study of cancer screening, risk communication, and overdiagnosis. The CE Core will provide specialized expertise in decision science, simulation modeling, risk communication, and qualitative research to efficiently support the Program’s comparative effectiveness and translational goals. In the next funding cycle, the CE Core will continue to provide comparative modeling services with three CISNET simulation models to translate short-term project results to a longer time horizon. Simulations will address the net benefits, harms, and equity impact of innovative breast cancer screening strategies that target screening at a woman level based on advanced cancer risk and will examine facility quality interventions aimed at improving screening use and performance in collaboration with Projects 1 and 2. In addition, qualitative research that will inform the clinical application of the Program’s innovative risk models will be used to identify barriers and facilitators of clinical adoption in collaboration with Project 3. The CE Core specific aims are to: 1) provide essential methodological expertise and model resources; 2) support evaluation of long-term comparative effectiveness of alternative woman-level screening strategies and facility-level quality intervention strategies to balance benefits, harms, and equity; 3) inform development and clinical application of the Program’s risk models for targeting breast imaging. Research supported by the CE Core will provide information on the most effective and equitable risk-based breast cancer screening and quality improvement strategies. Furthermore, CE Core supported findings will facilitate future dissemination and implementation studies focused on overcoming barriers to risk-based imaging. Centralization of modeling and other specialized services within the CE Core will enhance interactions across all Program components.