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3300万女性在这个 国家接受筛查乳房X光检查。尽管做出了巨大的研究和医疗保健提供努力 在乳腺癌筛查中，优化仍然受到关键问题的阻碍，包括：a) 持续过高的死亡率和晚期乳腺癌；b)显示与以下方面有关的危害 乳腺癌筛查；c)具体指南含糊不清；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)和 对个体的观察性研究。然而，乳腺癌筛查是在复杂的 医疗保健提供，包括个人、提供者、设施、组织和社区。目标是 只有通过研究乳房，才能在正确的时间用正确的测试筛选出正确的女性 在包含个人、提供者和实践级别的框架内进行癌症筛查 各种因素。以前工作的一个缺点是相对缺乏对决定 护理和最终筛选结果的过程。最近的医疗改革举措强调 预防保健、医疗院模式、问责制和信息系统的使用--所有这些都在运作 在系统层面上。在至少20年的乳腺癌筛查研究之后，转向检查 在系统内进行的筛选过程对于进一步提高筛选的有效性是必要的， 并针对女性个体和人群进行优化。该项目将提供一种系统化的方法来 整个筛查过程，并将医疗信息技术(IT)纳入改进战略，以 提高质量，最终提高妇女的成果。我们的主要目标是改进乳腺癌筛查 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，在不同的医疗保健提供系统中绘制整个乳房筛查过程， 为供应商和实践开发可概括的流程指标，并评估流程变更 卫生信息技术环境；(2)描述与以下方面有关的过程和筛查结果 妇女、提供者和实践级别的关联者；以及(3)开发和实施提供者和实践级别 用于测量和报告乳腺癌筛查过程的指标的仪表板工具。这项研究将 提供乳腺癌筛查系统整体工作方式的关键证据，哪些系统因素是 主要针对哪些妇女群体，并将开始提供改进分娩过程的工具 以便在对妇女个人和人口的伤害最小的情况下实现最大的利益。

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.