Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations (METRICS)

不同环境下宫颈癌筛查流程的多层次优化

基本信息

批准号：
10600841
负责人：
Jessica Chubak
金额：
$ 98.66万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
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：
2018-04-10 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10600841
关键词：
Address Adherence Affect Bayesian Method Cancer Control Research Caring Cervical Cervical Cancer Screening Cessation of life Clinic Clinical Collaborations Colposcopy Community Healthcare Complex County Data Data Sources Detection Development Diagnostic Disparity Effectiveness Electronics Eligibility Determination Epidemiologist Ethnic Origin Evaluation Exhibits Failure Geography Goals Guidelines HIV HIV Infections Harm Reduction Health Health system Healthcare Healthcare Systems High-Risk Cancer Hospitals Human Papilloma Virus Vaccine Human Papillomavirus Information Systems Intervention Knowledge Laboratories Lead Leadership Lesion Low income Malignant neoplasm of cervix uteri Managed Care Massachusetts Measures Methods Modeling Observational Study Oncogenic Organ Outcome Patients Physicians Policies Population Population Heterogeneity Prevention Prevention strategy Process Provider Race Research Research Activity Research Personnel Research Project Grants Resources Risk Risk Assessment Scientist Screening for cancer Service delivery model Subgroup System Technology Testing Texas Therapeutic immunosuppression Time Uninsured Variant Vulnerable Populations Washington Woman cancer invasiveness cancer type care systems cervical cancer prevention clinical practice cohort colorectal cancer screening community setting design disparity reduction ethnic minority experience follow-up health care delivery health care settings improved innovation lung cancer screening medical specialties multidisciplinary multilevel analysis new technology novel patient population payment personalized screening premalignant primary care provider programs provider networks racial minority safety net screening screening guidelines socioeconomics tool uptake

项目摘要

ABSTRACT For more than 5 decades, the US has sought to lower cervical cancer deaths through screening; however, disparities remain. Introduction of oncogenic human papillomavirus (HPV)-based tests and HPV vaccines have expanded cervical cancer prevention strategies and changed screening and management guidelines. As technology, guidelines, and policies change, our MultilEvel OpTimization of the CeRvIcal Cancer Screening Process in Diverse Settings & Populations (METRICS) PROSPR II Research Center will elucidate multilevel factors that hamper or facilitate the cervical cancer screening process and reduce disparities in vulnerable populations. METRICS unites three PROSPR I Research Centers with demonstrated capability to provide validated data for a combined cohort of ~1.2 million screened and unscreened women. Our community settings represent 3 care delivery models—safety-net system, managed care system, and primary care provider networks in Texas, Washington, and Massachusetts. We will collect, harmonize, and document > 10 years of high-quality, comprehensive cervical cancer screening process data at the patient, provider, clinic, and system levels using a rich array of electronic clinical information systems and novel data sources. Our combined cohort is socioeconomically and geographically diverse and includes vulnerable groups such as HIV-infected and uninsured women. Our three interconnected observational projects are designed to understand how cervical cancer screening is delivered across our spectrum of delivery models, and how to optimize the screening process to reduce disparities. Innovative geospatial and Bayesian statistical methods in Project 1 will better elucidate at what levels variation in screening process occurs. Project 2 will investigate how multilevel programs and policies influence adherence to guidelines for average-risk women. Project 3 will inform precision screening for women with altered risk. Based on our observational findings, in years 4-5, we will design and implement pilot interventions leveraging IT-enabled tools to address key failures in the screening process and reduce disparities. Our transdisciplinary team has epidemiologists, primary and specialty care physicians, and intervention, implementation, and healthcare delivery experts. We are poised to efficiently evaluate the full cervical cancer screening process and provide expertise, leadership, and resources for cross-organ PROSPR II collaborations. Our cores and research projects will achieve our goals of advancing understanding of screening as practiced in community settings through: (1) analysis of multilevel observational data from our heterogeneous settings with diverse populations, (2) development and testing of impactful interventions to optimize the screening process, and (3) application of our novel observational projects and quality metrics to the cancer screening processes for other organs. Based on our successful experience leading and collaborating in PROSPR I, we thoughtfully organized our four cores to be able to launch research activities and contribute to trans-PROSPR II activities quickly and effectively.

抽象的在过去的50多年中，美国试图通过筛查降低癌症的死亡。差异仍然存在。扩大了宫颈癌的预防策略，并改变了屏幕和管理指南技术，准则和政策变化，我们对宫颈癌筛查的多级优化各种环境与人口（指标）PROSPR II研究中心的过程将阐明多级阻碍或促进宫颈癌筛查过程并减少脆弱性差异的因素人群。验证了约120万筛查和未经筛查的妇女的总组合设置代表3种护理交付模型 - 安全网络系统，托管护理系统和初级护理德克萨斯州，华盛顿和马萨诸塞州的提供者网络。 10年的高质量，全面的宫颈癌筛查过程数据，提供者，提供者，诊所和系统水平使用丰富的电子临床信息系统和新型数据源。我们的组合队列在社会经济和地理上多样化，包括脆弱的群体例如感染HIV的妇女。旨在了解宫颈癌筛查的递送模型如何交付以及如何优化筛选过程以减少差异。项目1中的方法将在筛选过程中更好地阐明项目2 调查多级计划和政策如何影响普通风险妇女的准则。项目3将根据我们的观察发现，以改变风险。 4 - 5年，我们将设计和实施Pilot Pilot Pilot IT支持IT的工具工具工具工具工具关键故障在筛选过程中，我们的跨学科团队具有流行病学家我们准备好拥有专业护理护理护理医生以及国际，实施和医疗保健服务专家。有效评估完整的宫颈癌筛查过程，并提供专业知识，领导和资源对于跨器官II合作，我们的核心和研究项目将实现我们的目标通过：（1）分析社区环境中对筛查的理解来自不同人群的异质环境中的多级观察数据，（2）开发和测试有影响力的干预剂以优化筛选过程，以及（3）应用我们的小说基于我们的其他器官的癌症筛查过程的观察项目和质量指标在ProSpri领导和合作的成功经验能够启动研究活动并为Trans-Prospr II活动做出迅速有效的贡献。