Prescribe for health. Improving cancer screening in physician practices serving low-income and minority populations.
OBJECTIVE
To evaluate a health maintenance organization (HMO)-sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations.


METHODS
A randomized controlled trial with preintervention and postintervention measurements. Measurements were obtained by abstracting information from independent random samples of medical charts (N = 2316 at preintervention and 2238 at postintervention).


METHODS
Forty-seven primary care physician practices located in low-income and minority urban neighborhoods in Chicago, Ill.


METHODS
Practices were encouraged to adopt an office chart reminder system and to use a patient health maintenance card. Activities to facilitate the adoption of these items and for compliance with cancer screening guidelines included on-site training and start-up assistance visits, a physician continuing medical education seminar, and quality assurance visits with feedback to physicians.


METHODS
The proportions of patients with a chart-documented mammogram, clinical breast examination, Papanicolaou smear, or fecal occult blood slide test in the 2 years before preintervention and postintervention chart abstractions.


RESULTS
Between baseline and postintervention, there was a net increase in the proportion of HMO members in the intervention, compared with the control practices, who received in the preceding 2 years a Papanicolaou smear (11.9%) and a fecal occult blood slide test (14.1%). There was a net increase in the proportion of non-HMO patients in the intervention compared with the control practices who received a clinical breast examination (15.3%) and a fecal occult blood slide test (20.2%).


CONCLUSIONS
Implementation of an HMO-mediated, multicomponent intervention to improve cancer screening was feasible and effective for the Papanicolaou smear, fecal occult blood slide test, and the clinical breast examination, but not for mammography.
Manfredi
C
C
Health Research and Policy Centers, School of Public Health, University of Illinois at Chicago, USA. clara.manfredi@uic.edu
Czaja
R
R
Freels
S
S
Trubitt
M
M
Warnecke
R
R
Lacey
L
L
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002641:Chicago; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008507:Medically Underserved Area; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014504:Urban Health