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Prescribe for Health
Improving Cancer Screening in Physician Practices Serving Low-Income and Minority Populations
Clara Manfredi, PhD;
Ronald Czaja, PhD;
Sally Freels, PhD;
Mitchell Trubitt, MD;
Richard Warnecke, PhD;
Loretta Lacey, DrPH, RN
Arch Fam Med. 1998;7:329-337.
Objective To evaluate a health maintenance organization (HMO)–sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations.
Design 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).
Setting Forty-seven primary care physician practices located in low-income and minority urban neighborhoods in Chicago, Ill.
Intervention 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.
Main Outcome Measures 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.
From the Health Research and Policy Centers (Drs Manfredi, Warnecke, and Lacey) and Department of Epidemiology and Biostatistics (Dr Freels), School of Public Health, University of Illinois at Chicago; the Department of Sociology and Anthropology, North Carolina State University, Raleigh (Dr Czaja); and Chicago HMO of United Health Care of Illinois Inc (Dr Trubitt).
Dr Lacey was the initial principal investigator of the research project that generated the data we report. She contributed substantially to earlier drafts of this article, which is based on the work she initiated and guided. Dr Lacey died on May 31, 1994.
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