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.

抽象的五十多年来，美国一直试图通过筛查来降低宫颈癌死亡率；基于致癌人乳头瘤病毒 (HPV) 的检测和 HPV 疫苗的引入仍然存在差异。扩大了宫颈癌预防策略并改变了筛查和管理指南。技术、指南和政策的变化，我们对宫颈癌筛查的多层优化不同环境和人群中的过程（指标）PROSPR II 研究中心将阐明多层次阻碍或促进宫颈癌筛查过程并减少弱势群体差异的因素 METRICS 联合了三个具有提供能力的 PROSPR I 研究中心。验证了我们社区约 120 万已筛查和未筛查女性的综合数据。设置代表 3 种护理服务模式——安全网系统、管理式护理系统和初级护理我们将收集、协调和记录德克萨斯州、华盛顿州和马萨诸塞州的提供商网络。 10 年高质量、全面的宫颈癌筛查过程数据，涉及患者、提供者、诊所和系统级别使用丰富的电子临床信息系统和新颖的数据源。我们的综合群体在社会经济和地理上具有多样性，并且包括弱势群体例如感染艾滋病毒和未参保的妇女。我们的三个相互关联的观察项目是旨在了解如何在我们的一系列交付模式中进行宫颈癌筛查，以及如何优化筛选过程以减少创新的地理空间和贝叶斯统计。项目 1 中的方法将更好地阐明项目 2 筛选过程中将在什么水平上发生变化。调查多层次计划和政策如何影响对中等风险妇女的指导方针的遵守。项目 3 将根据我们的观察结果，为具有改变风险的女性提供精确筛查。第 4-5 年，我们将利用 IT 工具设计和实施试点干预措施来解决关键故障我们的跨学科团队拥有流行病学家、初级专家和专家。我们准备好了专业护理医生以及干预、实施和医疗保健提供专家。有效评估完整的宫颈癌筛查过程并提供专业知识、领导力和资源我们的核心和研究项目将实现我们的目标：通过以下方式增进对社区环境中筛查的理解：(1) 分析来自不同人群的异质环境的多层次观测数据，(2) 发展和测试有效的干预措施以优化筛选过程，以及（3）应用我们的新颖方法基于我们的其他器官癌症筛查过程的观察项目和质量指标。凭借在 PROSPR I 中领导和合作的成功经验，我们精心组织了我们的四个核心能够快速有效地开展研究活动并为跨 PROSPR II 活动做出贡献。