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Cited by 59Health Policy Implementation ScienceGlobal Cancer Incidence and ScreeningWomen's cancer prevention and management

Using an office system intervention to increase breast cancer screening

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Kinsinger, Linda S., Harris, Russell, Qaqish, Bahjat, Strecher, Victor, Kaluzny, Arnold·1998·Journal of General Internal Medicine
DOI 10.1046/j.1525-1497.1998.00160.xPMC PMC1497003
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Abstract

Objective To evaluate an innovative approach to continuing medical education, an outreach intervention designed to improve performance rates of breast cancer screening through implementation of office systems in community primary care practices. Design Randomized, controlled trial with primary care practices assigned to either the intervention group or control group, with the practice as the unit of analysis. Setting Twenty mostly rural counties in North Carolina. Participants Physicians and staff of 62 randomly selected family medicine and general internal medicine practices, primarily fee-for-service, half group practices and half solo practitioners. Intervention Physician investigators and facilitators met with practice physicians and staff over a period of 12 to 18 months to provide feedback on breast cancer screening performance, and to assist these primary care practices in developing office systems tailored to increase breast cancer screening. Measurements and main results Physician questionnaires were obtained at baseline and follow-up to assess the presence of five indicators of an office system. Three of the five indicators of office systems increased significantly more in intervention practices than in control practices, but the mean number of indicators in intervention practices at followup was only 2.8 out of 5. Cross-sectional reviews of randomly chosen medical records of eligible women patients aged 50 years and over were done at baseline (n = 2,887) and follow-up (n = 2,874) to determine whether clinical breast examinations and mammography, were performed. Results for mammography were recorded in two ways, mention of the test in the visit note and actual report of the test in the medical record. These reviews showed an increase from 39% to 51% in mention of mammography in intervention practices, compared with an increase from 41% to 44% in control practices (p = .01). There was no significant difference, however, between the two groups in change in mammograms reported (intervention group increased from 28% to 32.7%; control group increased from 30.6% to 34.0%, p = .56). There was a nonsignificant trend (p = .06) toward a greater increase in performance of clinical breast examination in intervention versus control practices. Conclusions A moderately intensive outreach intervention to increase rates of breast cancer screening through the development of office systems was modestly successful in increasing indicators of office systems and in documenting mention of mammography, but had little impact on actual performance of breast cancer screening. At follow-up, few practices had a complete office system for breast cancer screening. Outreach approaches to assist primary care practices implement office systems are promising but need further development.

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  1. McPhee SJ, Detmer W. Office-based interventions to improve de- livery of cancer prevention services by primary care physicians. Cancer. 1993;72:1100-2.

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Authors
Kinsinger, L. S., Harris, R., Qaqish, B., Strecher, V., & Kaluzny, A.
Affiliations
University of North Carolina at Chapel Hill (US)
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
1998-08
Volume
13
Issue
8
Pages
507-514
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1046/j.1525-1497.1998.00160.x
PMC
PMC1497003
OpenAlex
W2080693544
Cited by
59
References
32
Citations by year
2025: 1 · 2024: 1 · 2019: 1 · 2018: 2 · 2015: 3 · 2014: 2 · 2013: 3 · 2012: 5
FWCI
5.49
Type
journal article
Language
en
Open access
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01ca054343-04)
  • National Cancer Institute (CA 54343-02)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
breast cancer screening, office systems, continuing medical education, outreach interventions, primary care practices, mammography, clinical breast examination, performance feedback, rural primary care, quality improvement, fee-for-service
MeSH terms
Aged, Attitude of Health Personnel, Breast Neoplasms, Community Medicine, Cross-Sectional Studies, Education, Medical, Continuing, Female, Humans, Mammography, Mass Screening, Middle Aged, North Carolina, Practice Management, Medical, Primary Health Care, Surveys and Questionnaires, Rural Population, Confidence Intervals, Logistic Models, Odds Ratio

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