Research Project 2

综合护理在乳腺癌快速诊断中的实施 摘要 符合世卫组织改善全球乳腺癌倡议的第二个支柱 乳腺癌(BC)控制在LMICs，我们的长期目标是提高治疗的及时性 墨西哥的乳腺癌诊断。拟议研究的目标是开发和测试 旨在改善快速业务连续性综合护理的实施战略 初诊患有BC的妇女在卫生系统水平上的诊断 护理设置。具体目标是： (1)评估实施以下各项的障碍、促进者和组织准备情况 BC快速诊断系统。我们将与医疗保健部门进行定性访谈 人员(由CFIR和ISF框架通知)，以确定障碍和促进者 以供实施。此外，我们还将跨文化调整R=MC 2的测量和评估 为未参保人群提供服务的166个初级保健中心的组织准备情况 新莱昂州蒙特雷的人口。(2)制定战略，改善 实现了一个BC快速诊断系统。在中使用实现映射 与主要利益相关者协作，我们将根据具体情况进行设计 实施战略(包括实践促进)，以解决障碍和 加强组织对实施综合护理的准备，这将 启用快速诊断。(3)评估练习便利化对 结肠炎快速诊断系统的实现及对患者疗效的判定 结果。我们将使用以下工具进行第二类混合实施-有效性研究 整群随机阶梯楔形设计。主要执行成果：减少 从在初级保健诊所出现症状到到达 诊断性诊所。有效结果：BC期疗效下降。建议数 研究将解决墨西哥(和其他LMIC)在BC控制方面的迫切需求，以及 通过改编和验证西班牙语来推进实施科学 组织就绪性测量和评估实践促进的使用 为在低收入国家实施癌症控制实践变革做好准备。

Implementation of integrated care for rapid breast cancer diagnosis ABSTRACT Consistent with the second pillar of WHO's Global Breast Cancer Initiative for improving breast cancer (BC) control in LMICs, our long-term goal is to improve the timeliness of breast cancer diagnosis in Mexico. The goal of the proposed study is to develop and test implementation strategies designed to improve integrated care for rapid BC diagnosis across health system levels among women presenting with BC in primary care settings. The Specific Aims are: (1) Assess barriers, facilitators, and organizational readiness for implementation of rapid BC diagnosis system. We will conduct qualitative interviews with healthcare personnel (informed by CFIR and ISF frameworks) to identify barriers and facilitators for implementation. Also, we will cross culturally adapt the R=MC 2 measure and assess organizational readiness across the 166 primary care centers that serve the uninsured population in Monterrey, Nuevo León. (2) Develop strategies to improve the implementation of a rapid BC diagnosis system. Using Implementation Mapping in collaboration with the key stakeholders, we will design contextually appropriate implementation strategies (including practice facilitation) to address barriers and strengthen organizational readiness for implementation of integrated care that will enable rapid diagnosis. (3) Evaluate the impact of practice facilitation on implementation of a rapid BC diagnosis system and determine effectiveness on patient outcomes. We will conduct a hybrid type 2 implementation-effectiveness study using a cluster randomized stepped-wedge design. Primary implementation outcome: reduction in the time between symptomatic presentation at the primary care clinics and arrival to the diagnostic clinic. Effectiveness outcome: down-shift in the stage of BC. The proposed study will address a pressing need in BC control in Mexico (and other LMICs), and advance implementation science by adapting and validating a Spanish language organizational readiness measure and evaluating the use of practice facilitation to improve readiness for implementation of cancer control practice change in LMICs.