title: Systems strategies to support cancer screening in U.S. primary care practice.
abstract: BACKGROUND
  Although systems strategies are effective in improving health care delivery, little is known about their use for cancer screening in U.S. primary care practice.
  
  
  METHODS
  We assessed primary care physicians' (N = 2,475) use of systems strategies for breast, cervical, and colorectal cancer (CRC) screening in a national survey conducted in 2007. Systems strategies included patient and physician screening reminders, performance reports of screening rates, electronic medical records, implementation of in-practice guidelines, and use of nurse practitioners/physician assistants. We evaluated use of both patient and physician screening reminders with other strategies in separate models by screening type, adjusted for the effects of physician and practice characteristics with multivariate logistic regression.
  
  
  RESULTS
  Fewer than 10% of physicians used a comprehensive set of systems strategies to support cancer screening; use was greater for mammography and Pap testing than for CRC screening. In adjusted analyses, performance reports of cancer screening rates, medical record type, and in-practice guidelines were associated with use of both patient and physician screening reminders for mammography, Pap testing, and CRC screening (P < 0.05).
  
  
  CONCLUSIONS
  Despite evidence supporting use of systems strategies in primary care, few physicians report using a comprehensive set of strategies to support cancer screening.
  
  
  CONCLUSIONS
  Current health policy initiatives underscore the importance of increased implementation of systems strategies in primary care to improve the use and quality of cancer screening in the United States.
authors: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA. yabroffr@mail.nih.gov
authors: K Robin
authors: KR
authors: Yabroff
authors: Jane
authors: J
authors: Zapka
authors: Carrie N
authors: CN
authors: Klabunde
authors: Gigi
authors: G
authors: Yuan
authors: Dennis W
authors: DW
authors: Buckman
authors: David
authors: D
authors: Haggstrom
authors: Steven B
authors: SB
authors: Clauser
authors: Jacqueline
authors: J
authors: Miller
authors: Stephen H
authors: SH
authors: Taplin
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D014481:United States