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    Awarded Grants
    Field Trial of Mobile Digital Telemammography - Phase II

    Scientific Abstract:
    Tracking ID Number - POP0402394 Field Trial of Mobile Digital Telemammography – Phase II Scientific Abstract Background: This project was planned around the use of a mobile unit designed to provide “real time” digital mammography and other health services to women in remote and underserved areas. The plan included the integration of high-speed satellite telecommunications with advanced computer technology to support breast cancer screening and diagnostic services to women who do not have convenient access to high quality care. Through the use of this innovative approach, which makes a diagnostic report available to women while they are still at the mobile unit, it is expected that patient participation will increase, as will patient compliance with follow up recommendations. With the support of the Komen Foundation, Phase I was completed in 2002. Phase I focused on the technical feasibility of integrating digital mammography in a mobile setting, transmitting the images via satellite for immediate interpretation and providing the results to the patient. The design of Phase II is based upon the successful completion of Phase I and the collaboration of the Aberdeen Area Indian Health Service and local tribal organizations to conduct a demonstration and evaluation among Sioux tribes in North and South Dakota. Objective/Hypothesis: The general hypothesis to be tested in Phase II is: “there are no significant differences between conventional mammography services and Mobile Digital Telemammography (MDT) care delivered to underserved women in the participating communities.” The specific parameters to be tested include measures of participation, compliance with follow up recommendations, short-term outcome, and costs and benefits. This will be accomplished by comparing data available from previous programs, and from a comparable control group in the Aberdeen Area, with data recorded in conjunction with the MDT field trial. Specific Aims: The project goals include a demonstration and evaluation of this innovative concept based upon the recommendations of an NIH workshop in 1996. The recommendations included an evaluation of the mobile unit and its telecommunications capabilities in improving women’s access to high quality care and to facilitate expert mammography interpretation and immediate referral for follow up. It is expected that the evaluation will indicate the applicability of this approach to women in other underserved areas. Study Design: The evaluation will include a population of ten thousand eligible women in participating service areas from which approximately six thousand will participate and be examined during the two year program. The digital mammography examinations will be transmitted to centers of excellence for immediate interpretation and prompt reporting. The images will include previous examinations when they are available. Pertinent data from the patient’s medical record will be recorded for comparison with the information gathered on the examinations performed in the mobile unit. These data will be made available, under strict security measures in accordance with HIPAA regulations to protect patient privacy, to measure the effectiveness of the community awareness program and the efficacy of the delivery of health care. Potential Outcomes and Benefits of the Research: This “real-time” approach to providing mammography examinations and to improve access to other women’s health services, is intended to be a replicable activity that can be offered to other underserved segments of our population. Using the new technologies, it is possible to deliver high quality care to women anywhere; distance is no longer an impediment. This is especially pertinent to mammography, where the approach ensures that the images are interpreted by expert radiologists at centers of excellence.

    Lay Abstract:
    Tracking ID Number - POP0402394 Field Trial of Mobile Digital Telemammography – Phase II Lay Abstract This proposed demonstration and evaluation project is intended to provide high quality mammographic and other health services to women in underserved areas. The project is based upon the premise that the value of early detection of breast cancer has been widely accepted by recognized authorities in medical research and practice, and that mammography is the most efficacious method of providing screening and diagnostic examinations. The concept of combining mobility and high-speed telecommunications with digital mammography was developed over a five-year period by a consortium of universities, industry, and government. With the support of the Komen Foundation, Phase I was completed in 2002. The objectives of Phase I were focused on the technical feasibility of utilizing digital mammography in a mobile setting, transmitting the images via satellite for immediate interpretation at centers of excellence, and providing the results to the patient before she left the examination site. Phase II is proposed to be conducted among the Sioux tribes in North and South Dakota and will include baseline data and operational measures that will address patient participation, compliance with follow up recommendations, and the costs and benefits of the program. In addition to digital mammography, PAP smears, breast examinations, bone densitometry, and diabetes testing will be available to participating women on the mobile unit. The authors of this proposal are convinced of the value of early detection in reducing breast cancer mortality and, based upon the results of Phase I, plan to provide mammography and other health services to women with limited access to high quality care. It is expected that the proposed field trial, with this innovative mix of advanced technology, will also mitigate the shortage of qualified radiologists by efficient transmission of digital images for interpretation at centers of excellence, and will provide reliable information on costs and benefits related to reimbursement issues. With the collaboration of the Aberdeen Indian Health Service and local tribal organizations, a targeted community outreach program will be initiated among the participating health service areas. This will be aimed at increasing patient awareness of the benefits of mammography and the importance of complying with follow up recommendations. The project plan also provides for the collection of specific information, under strict security measures, to protect patient privacy to measure the effectiveness of the community awareness and health care delivery programs. It is expected that the prompt interpretation of the mammography examination and the patient’s immediate knowledge of the results, will facilitate patient participation and increase compliance with follow up recommendations. The detailed plan also includes an economic analysis to estimate the costs and benefits of this innovative approach in comparison with conventional methods of providing mammography services.