title: Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice.
abstract: Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known.
  
  
  
  To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH).
  
  
  
  Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening.
  
  
  
  Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers.
  
  
  
  The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up.
  
  
  
  There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guideline-adherent breast (OR 3.23, 95 % CI 1.58-6.61) or cervical (OR 2.56, 95 % CI 1.32-4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 % CI 1.15-41.7) or cervical (OR. 2.56, 95 % CI 1.26-5.26) cancer screening.
  
  
  
  Providers lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline-adherent cancer screening in primary care settings.
authors.affiliation: University of Pennsylvania and the Philadelphia VA Medical Center, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA. mschap@upenn.edu.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: University of Vermont, Burlington, VT, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.affiliation: Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.affiliation: Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Elisabeth F
authors.initials: EF
authors.lastname: Beaber
authors.affiliation: Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: University of Vermont, Burlington, VT, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: MacLean
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Harris
authors.affiliation: University of Vermont, Burlington, VT, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Howe
authors.affiliation: Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Loretta
authors.initials: L
authors.lastname: Pearson
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Feldman
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Brawarsky
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital, Boston, MA, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D020000:Decision Support Systems, Clinical / Q000592:standards; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration / Q000592:standards; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D017010:Reminder Systems / Q000706:statistics & numerical data; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
keywords: breast cancer screening; cervical cancer screening; patient-centered medical home