基于 PRECEDE-PROCEED 模式的筛查项目审核系统的开发与首次应用：在意大利伦巴第大区（意大利）进行乳腺癌筛查的经验。
Development and first application of an audit system for screening programs based on the PRECEDE-PROCEED model: an experience with breast cancer screening in the region of Lombardy (Italy).
机构信息
DG Welfare, Regione Lombardia, Milano, Italy.
Direzione Generale della Prevenzione, Ministero della Salute, Rome, Italy.
出版信息
BMC Public Health. 2020 Nov 25;20(1):1778. doi: 10.1186/s12889-020-09842-8.
BACKGROUND
High participation and performance are necessary conditions for the effectiveness of breast cancer screening programs. Here we describe the process to define and test a planning software application and an audit cycle based on the PRECEDE-PROCEED model applied to improving breast cancer screening. We developed a planning software application following the phases of the PRECEDE-PROCEED model. The application was co-designed by local cancer screening program coordinators. An audit model was also developed. The revised application and the audit model were tested by all the coordinators of 15 breast cancer screening programs in the region of Lombardy in a 3-day workshop. The project plans produced using the application were compared with those produced in the previous year for clarity and completeness.
RESULTS
The 9 phases of the PRECEDE-PROCEED model were adapted to screening as follows: 1) identification of program goals (i.e., participation, sensitivity, false positive); 2) epidemiological issues; 3) best practices analysis; 4) evidence-based actions to be implemented in the screening center and the relationships with partners and stakeholders; 5) priority setting and identification of solutions for each issue; 6) definition of indicators; 7) monitoring; 8) evaluation; 9) impact assessment. The application automatically generated reports for each phase. During the audit cycle, the regional health authority negotiated the targets to be reached with local authorities and collected the improvement plans generated by the application. The plans produced after the application was adopted were more standardized and had clearer indicators for monitoring and evaluation compared to those produced in the previous year.
CONCLUSIONS
The software application helps standardize criteria for planning interventions to improve screening programs and facilitates the implementation of the audit cycle.
背景
高参与度和高绩效是乳腺癌筛查项目有效性的必要条件。在此，我们描述了一种定义和测试规划软件应用程序和审核周期的流程，该流程基于应用于改善乳腺癌筛查的 PRECEDE-PROCEED 模型。我们按照 PRECEDE-PROCEED 模型的阶段开发了一个规划软件应用程序。该应用程序由当地癌症筛查项目协调员共同设计。还开发了一个审核模型。在为期三天的研讨会上，伦巴第大区 15 个乳腺癌筛查项目的所有协调员对修订后的应用程序和审核模型进行了测试。使用该应用程序生成的项目计划与前一年生成的计划进行了比较，以评估其清晰度和完整性。
结果
PRECEDE-PROCEED 模型的 9 个阶段被适用于筛查，如下所示：1）确定项目目标（即参与度、敏感度、假阳性）；2）流行病学问题；3）最佳实践分析；4）在筛查中心实施的循证行动以及与合作伙伴和利益相关者的关系；5）确定每个问题的优先级并确定解决方案；6）定义指标；7）监测；8）评估；9）影响评估。该应用程序自动为每个阶段生成报告。在审核周期中，区域卫生当局与地方当局协商要达到的目标，并收集应用程序生成的改进计划。与前一年相比，采用该应用程序后生成的计划更加标准化，并且具有更明确的监测和评估指标。
结论
该软件应用程序有助于为改善筛查项目的干预措施规划标准化标准，并促进审核周期的实施。
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