Evaluating breast cancer care in rural Rwanda

评估卢旺达农村地区的乳腺癌护理

基本信息

批准号：
10335130
负责人：
Lydia Pace
金额：
$ 17.47万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-02-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10335130
关键词：
Address Africa South of the Sahara African Age Aging Breast Breast Cancer Patient Breast Cancer Risk Factor Breast Cancer Treatment Cancer Center Cancer Control Caring Cause of Death Cessation of life Characteristics Clinical Clinical Research Collaborations Cost Analysis Country Dana-Farber Cancer Institute Data Data Collection Developing Countries Development Diagnosis Diagnostic Dimensions Effectiveness of Interventions Evaluation Financial Support Fostering Foundations General Population Goals Growth Health Health Services Health Services Accessibility Health system Hospitals Incidence Income Individual Institution International Intervention Intervention Trial Investigation K-Series Research Career Programs Logistics Low income Malignant Neoplasms Measures Medical Records Mentors Mentorship Methods Mission National Cancer Institute Nongovernmental Organizations Oncologist Oncology Operative Surgical Procedures Outcome Paper Patients Population Poverty Provider Public Health Public Health Schools Quality of Care Records Research Research Infrastructure Research Personnel Research Training Resource Allocation Resource Development Resource-limited setting Rural Rwanda Site Specialized Center Staging Standardization System Time Time trend Training Treatment Protocols Universities Ursidae Family Woman Work anticancer research breast exam cancer care cancer referral center cancer therapy care delivery care outcomes career clinical care clinical infrastructure comparative cost effectiveness cost cost effective cost effectiveness cost-effectiveness evaluation economic evaluation experience follow-up global health hazard implementation science improved innovation international partnership low and middle-income countries low income country malignant breast neoplasm mortality multidisciplinary program costs programs residence rural patients skills sociodemographics surgical service treatment program tumor

Address Africa South of the Sahara African Age Aging Breast Breast Cancer Patient Breast Cancer Risk Factor Breast Cancer Treatment Cancer Center Cancer Control Caring Cause of Death Cessation of life Characteristics Clinical Clinical Research Collaborations Cost Analysis Country Dana-Farber Cancer Institute Data Data Collection Developing Countries Development Diagnosis Diagnostic Dimensions Effectiveness of Interventions Evaluation Financial Support Fostering Foundations General Population Goals Growth Health Health Services Health Services Accessibility Health system Hospitals Incidence Income Individual Institution International Intervention Intervention Trial Investigation K-Series Research Career Programs Logistics Low income Malignant Neoplasms Measures Medical Records Mentors Mentorship Methods Mission National Cancer Institute Nongovernmental Organizations Oncologist Oncology Operative Surgical Procedures Outcome Paper Patients Population Poverty Provider Public Health Public Health Schools Quality of Care Records Research Research Infrastructure Research Personnel Research Training Resource Allocation Resource Development Resource-limited setting Rural Rwanda Site Specialized Center Staging Standardization System Time Time trend Training Treatment Protocols Universities Ursidae Family Woman Work anticancer research breast exam cancer care cancer referral center cancer therapy care delivery care outcomes career clinical care clinical infrastructure comparative cost effectiveness cost cost effective cost effectiveness cost-effectiveness evaluation economic evaluation experience follow-up global health hazard implementation science improved innovation international partnership low and middle-income countries low income country malignant breast neoplasm mortality multidisciplinary program costs programs residence rural patients skills sociodemographics surgical service treatment program tumor

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项目摘要

PROJECT SUMMARY The burden of breast cancer is rising in low- and middle-income countries (LMICs), including in sub- Saharan Africa, and the gap between breast cancer mortality in low- versus high-income countries is widening. Data are highly limited about quality of and outcomes from breast cancer care in sub-Saharan Africa, though available evidence shows that quality is often inadequate. To reduce global disparities in breast cancer outcomes, better data are needed to guide effective breast cancer treatment programs that are cost-effective, feasible, and accessible to sub-Saharan Africa's general population. The goal of this K07 Career Development Award is to foster Dr. Lydia Pace's growth into an independent researcher with the skills needed to conduct rigorous investigation of breast cancer control in LMICs. Dr. Pace will benefit from mentorship by Dr. Nancy Keating, an internationally recognized cancer health services researcher and acclaimed mentor with expertise in cancer care quality, Dr. Lawrence Shulman, an accomplished breast oncologist and leader in global cancer control, and Dr. Jane Kim, an expert in cost- effectiveness with extensive experience in women's cancers in developing countries. Dr. Pace will pursue courses at the Harvard T.H. Chan School of Public Health and additional research training at Harvard University, affiliated hospitals, and the National Cancer Institute. She will take advantage of close collaboration with the organization Partners in Health and its experience in implementation science, economic evaluation, and cancer programs. She will work closely with her existing network of colleagues in Rwanda's Ministry of Health and Butaro Cancer Center of Excellence (BCCOE), Rwanda's first public cancer referral center. We will leverage this international partnership, existing research collaborations, and a robust data collection system to assess breast cancer care at BCCOE. The aims of this project are to 1) identify relevant breast cancer care quality measures for BCCOE and similarly resource-limited settings; 2) measure quality of breast cancer care at BCCOE and assess factors impacting quality; 3) assess time trends in breast cancer stage and survival at BCCOE, identifying the relationships between quality, health system and patient factors, and outcomes; 4) quantify costs of breast cancer treatment at BCCOE, and examine the cost-effectiveness of interventions to optimize quality. For Aim 1, we will utilize the modified Delphi method to engage an expert panel in refining a set of quality measures. For Aims 2 and 3 we will review BCCOE medical records and analyze the data using multivariate logistic and Cox proportional hazards regression. For Aim 4 we will perform detailed costing analysis and compare the costs and effectiveness of optimal versus current care. Together with strong mentorship, courses, and rich global collaboration, this project will facilitate Dr. Pace's growth into an independent investigator and prepare her for an R01 to develop interventions to improve breast cancer care at BCCOE, with the ultimate goal of reducing breast cancer mortality in Rwanda and beyond.

项目摘要在低收入国家（LMIC）中，乳腺癌的负担正在增加，包括撒哈拉非洲以及低收入国家和高收入国家的乳腺癌死亡率之间的差距正在扩大。数据对撒哈拉以南非洲乳腺癌护理的质量和结果的质量受到极大限制，尽管可用证据表明，质量通常不足。减少乳腺癌的全球差异结果，需要更好的数据来指导具有成本效益的有效乳腺癌治疗计划，可行的，可容纳撒哈拉以南非洲的一般人口。这个K07职业发展奖的目标是促进Lydia Pace博士的成长为独立研究人员具有对LMIC中乳腺癌控制的严格研究所需的技能。佩斯博士国际认可的癌症卫生服务部Nancy Keating博士将受益研究人员和备受赞誉的导师具有癌症护理质量专业知识，劳伦斯·舒尔曼（Lawrence Shulman）博士，全球癌症控制的乳房肿瘤学家和领导者，成本成本的专家Jane Kim博士在发展中国家的女性癌症中有丰富经验的有效性。佩斯博士将追求哈佛T.H.的课程陈公共卫生学院和哈佛大学的其他研究培训大学，附属医院和国家癌症研究所。她将利用密切合作与组织合作伙伴及其在实施科学方面的经验，经济评估，和癌症计划。她将与卢旺达部现有的同事网络紧密合作 Health和Butaro Cancer Excellence（BCCOE）是卢旺达第一个公共癌症转诊中心。我们将利用这种国际合作伙伴关系，现有的研究合作和强大的数据收集评估BCCOE乳腺癌护理的系统。该项目的目的是1）确定相关的乳房 BCCOE和类似资源有限的设置的癌症护理质量指标； 2）测量乳房的质量 BCCOE的癌症护理并评估影响质量的因素； 3）评估乳腺癌阶段的时间趋势和在BCCOE生存，确定质量，卫生系统和患者因素之间的关系以及结果； 4）量化BCCOE乳腺癌治疗的成本，并检查干预措施以优化质量。对于AIM 1，我们将利用修改后的Delphi方法参与专家精炼一组质量措施的面板。对于目标2和3，我们将审查BCCOE病历，并使用多元逻辑和COX比例危害回归分析数据。对于目标4，我们将表演详细的成本核算分析并比较最佳护理与当前护理的成本和有效性。连同强大的指导，课程和丰富的全球合作，该项目将有助于Pace博士的成长为独立研究者，并为她准备R01来开发干预措施以改善乳房 BCCOE的癌症护理，其最终目标是降低卢旺达及以后的乳腺癌死亡率。