Implementing USPSTF Recommendations for Breast Cancer Screening and Prevention by Integrating Clinical Decision Support Tools with the Electronic Health Record

项目摘要/摘要 乳腺癌筛查和预防的临床建议取决于乳腺癌风险， 然而，为6300万有资格获得服务的妇女准确确定风险的方法在 练习一下。MammoScreen是一款基于Web的临床决策支持工具应用程序，专为女性设计 年龄在40-74岁之间，以确定自己患乳腺癌的风险，让患者参与共同的决策， 指导推荐，并考虑筛选决定。患者根据他们的风险获得量身定制的信息 符合USPSTF建议的简档和首选项。这种数字化医疗的目标是 研究项目旨在改善妇女的机会和护理质量，妇女是AHRQ的优先人群。 尽管许多乳腺癌风险评估工具是公开可用的，但没有一个与 患者的电子健康记录(EHR)，错过了完全整合患者的重要机会 在护理地点将信息纳入预防决策。MammoScreen是开发的，之前 由跨学科调查组为拟议的项目进行测试。在一项试点研究中，来自 MammoScreen需要手动进入EHR，这在大型医疗系统中是不可行的。 建议的项目创新地使用了SMART(可替代医疗应用程序，可再利用 技术)在FHIR(快速医疗互操作性资源)标准上交换数据 电子病历外部的应用程序，如MammoScreen，将其完全集成到常规医疗保健中。这个 使用SMART ON FHIR标准将允许该方法不仅扩展到单个医疗系统， 而是任何支持SMART ON FHIR标准的EHR系统。 本项目的目标是展示电子病历安全交换信息的能力 MammoScreen使用可互操作的、基于标准的方法；提供适当的临床和患者 为用户提供决策支持；并使用基于以下内容的混合方法评估其在患者和临床医生中的使用 RE-AIM框架(REACH、有效性、采用、实施和维护)。完成 这些目标将为与其他类型的医疗保健相关应用程序集成奠定基础 旨在将决策支持扩展到临床环境之外。 目标1(第1年和第2年)：实施基于标准、安全、可靠、可互操作的 乳房屏幕与电子病历。 目标2(第1年和第2年，第3和第4年)评估患者对乳房筛查的接受度 临床医生识别和消除潜在的使用障碍。 目标3(3-5岁)：评估不同年龄段的临床医生和患者对EHR集成乳房筛查的使用 分组(40-49岁；50-74岁)，并衡量临床结果。

Project Summary/Abstract Clinical recommendations for breast cancer screening and prevention are contingent on breast cancer risk, yet methods to accurately determine risk for the 63 million women eligible for services are not widely used in practice. MammoScreen, a web-based application of a clinical decision support tool, was designed for women ages 40–74 years to identify their individual risks for breast cancer, engage patients in shared decision making, guide referrals, and consider screening decisions. Patients receive tailored information based on their risk profiles and preferences in accordance with USPSTF recommendations. The goal of this digitial healthcare research project is to improve access and quality of care for women, an AHRQ priority population. Although numerous breast cancer risk assessment tools are publically available, none exchange data with the patient’s electronic health record (EHR), missing important opportunities to fully integrate patient information into prevention decision-making at point of care. MammoScreen was developed and previously tested by the interdisciplinary team of investigators for the proposed project. In a pilot study, data from MammoScreen required manual entry into the EHR, which is not feasible across large health systems. The proposed project makes innovative use of the SMART (Substitutable Medical Applications, Resuable Technologies) on FHIR (Fast Healthcare Interoperability Resources) standard to exchange data to and from applications external to the EHR, such as MammoScreen, to fully integrate them into routine healthcare. The use of the SMART on FHIR standard will allow this approach to be scaled not only to a single health system, but to any EHR system that supports the SMART on FHIR standard. The objectives of this project are to demonstrate the ability of the EHR to securely exchange information with MammoScreen using interoperable, standards-based approaches; provide appropriate clinical and patient decision support for users; and evaluate its use among patients and clinicians using mixed methods based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). Accomplishing these goals would lay the groundwork for integration with other types of healthcare-related applications designed to extend decision support outside the clinical setting. Aim 1 (Years 1 & 2): Implement standards-based, safe, secure, interoperable integration of MammoScreen with the EHR. Aim 2 (Year 1 & 2 and again, Years 3 & 4) Evaluate MammoScreen acceptance by patients and clinicians to identify and remove potential barriers to use. Aim 3 (Years 3-5): Evaluate use of EHR-integrated MammoScreen by clinicians and patients across age groups (40–49 years; 50–74 years) and measure clinical outcomes.