PRESCRIBE FOR HEALTH - IMPROVING CANCER SCREENING IN PHYSICIAN PRACTICES SEWING LOW-INCOME AND MINORITY POPULATIONS

Objective: To evaluate a health maintenance organization (HMO)-sponsor ed intervention to improve cancer screening in private physician pract ices serving low-income, minority populations. Design: A randomized co ntrolled trial with preintervention and postintervention measurements. Measurements were obtained by abstracting information from independen t random samples of medical charts (N = 2316 at preintervention and 22 38 at postintervention). Setting: Forty-seven primary care physician p ractices located in low-income and minority urban neighborhoods in Chi cago, Ill. Intervention: Practices were encouraged to adopt an office chart reminder system and to use a patient health maintenance card. Ac tivities to facilitate the adoption of these items and for compliance with cancer screening guidelines included on-site training and start-u p assistance visits, a physician continuing medical education seminar, and quality assurance visits with feedback to physicians. Main Outcom e Measures: The proportions of patients with a chart-documented mammog ram, clinical breast examination, Papanicolaou smear, or fecal occult blood slide test in the 2 years before preintervention and postinterve ntion chart abstractions. Results: Between baseline and postinterventi on, there was a net increase in the proportion of HMO members in the i ntervention, compared with the control practices, who received in the preceding 2 years a Papanicolaou smear (11.9%) and a fecal occult bloo d slide test (14.1%). There was a net increase in the proportion of no n-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-media ted, multicomponent intervention to improve cancer screening was feasi ble and effective for the Papanicolaou smear, fecal occult blood slide test, and the clinical breast examination, but not for mammography.