CANCER EARLY-DETECTION SERVICES IN COMMUNITY-HEALTH CENTERS FOR THE UNDERSERVED - A RANDOMIZED CONTROLLED TRIAL

Background: Achieving cancer early-detection goals remains a challenge , especially among low-income and minority populations. Design/Setting : A randomized trial based in 62 community health centers for the unde rserved in New York, New Jersey, and western Connecticut. Family physi cians were on staff at most of the centers. Intervention: Workshops, m aterials, and ongoing advice for center leaders promoted implementatio n of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, o ther tools, and staff involvement. Evaluation End Points: The proporti on of randomly selected patients by center who were up to date for ind icated services at baseline (n = 2645) and follow-up (n = 2864) record review. Results: Only 1 service (breast self-examination advice) incr eased more in intervention centers. Seven of 8 target services increas ed significantly for the 62 centers overall. During the study, the med ical director changed in 26 centers (42%). Keeping the same medical di rector at intervention centers was associated with improvements in ser vices. Conclusions: Cancer early-detection services are improving in c ommunity health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention r equired that there be no change in medical director. The relationship of changes in the practice environment to services delivered is comple x and deserves more study.