A Practice Facilitation and Academic Detailing Intervention Can Improve Cancer Screening Rates in Primary Care Safety Net Clinics.
Despite the current evidence of preventive screening effectiveness, rates of breast, cervical, and colorectal cancer in the United States fall below national targets. We evaluated the efficacy and feasibility of combining practice facilitation and academic detailing quality improvement (QI) strategies to help primary care practices increase breast, cervical, and colorectal cancer screening among patients.



Practices received a 1-hour academic detailing session addressing current cancer screening guidelines and best practices, followed by 6 months of practice facilitation to implement evidence-based interventions aimed at increasing patient screening. One-way repeated measures analysis of variance compared screening rates before and after the intervention, provider surveys, and TRANSLATE model scores. Qualitative data were gathered via participant focus groups and interviews.



Twenty-three practices enrolled in the project: 4 federally qualified health centers, 10 practices affiliated with larger health systems, 4 physician-owned practices, 4 university hospital clinics, and 1 nonprofit clinic. Average screening rates for breast cancer increased by 13% (P = .001), and rates for colorectal cancer increased by 5.6% (P = .001). Practices implemented a mix of electronic health record data cleaning workflows, provider audits and feedback, reminder systems streamlining, and patient education and outreach interventions. Practice facilitators assisted practices in tailoring interventions to practice-specific priorities and constraints and in connecting with community resources. Practices with resource constraints benefited from the engagement of all levels of staff in the quality improvement processes and from team-based adaptations to office workflows and policies. Many practices aligned quality improvement interventions in this project with patient-centered medical home and other regulatory reporting targets.



Combining practice facilitation and academic detailing is 1 method through which primary care practices can achieve systems-level changes to better manage patient population health.
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Emily M
EM
Mader
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Chester H
CH
Fox
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
John W
JW
Epling
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Gary J
GJ
Noronha
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Carlos M
CM
Swanger
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Angela M
AM
Wisniewski
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Karen
K
Vitale
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Amanda L
AL
Norton
From the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM). morleycp@upstate.edu.
Christopher P
CP
Morley
D001943:Breast Neoplasms / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000175:diagnosis; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D019317:Evidence-Based Medicine / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D058996:Quality Improvement; D064876:Safety-net Providers / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis
Analysis of Variance; Breast Cancer; Cancer Prevention & Control; Cervical Cancer; Colorectal Cancer; Early Detection of Cancer; Focus Groups; Improvement; Primary Health Care; Quality; Reminder Systems; Surveys & Questionnaires; Workflow