Cancer Control Research3R01CA068378-04S1
Ransohoff, David F.
CANCER PREVENTION IN PRIMARY CARE--PRACTICE ACTIVATION
We are conducting a quasi-experimental study in 68 primary care practices in two medium and two smaller size cities in North Carolina to determine the extent to which an innovative intervention based on affecting predisposing, enabling, and reinforcing factors to promote adoption and maintenance of an effective cancer prevention office system, will increase the performance of preventive activities for four cancers (screening for breast, cervical, and colorectal cancers, and smoking cessation counseling for lung cancer), compared with practices not exposed to the program. Practices will be part of one of two conditions. The control group practices will receive no assistance. The intervention group will receive a special program, beginning with identifying a small group of physicians and office staff members within each practice who will agree to attend small group sessions to find ways to optimize cancer prevention in their practices. The purpose of these groups is to allow participants in an early stage of adoption to step back from their practices and appropriately prioritize cancer prevention activities. When physician/office staff from each practice are ready, the project will work with them to institute a process, such as continuous quality improvement, to allow their practice to design and implement a cancer prevention office system, tailored to the special needs of the practice. They will receive support for skills training, system options, and computer assessment. A major factor in the intervention is developing social influences among physicians in the intervention communities to encourage higher performance of cancer prevention activities. The control group will receive all that is learned from the program at the end of the project. The effect of the intervention will measured by the change from baseline to post intervention periods in the proportion of eligible patients with documented performance of the cancer prevention activities in intervention as compared with control practices, as determined by medical record reviews. We will also examine whether the intervention has a differential effect for different activities or on different patient groups, such as those having Independent Practice Association (IPA) insurance coverage or those who are members of a disadvantaged group. We will also follow over time the association of changes in the IPA approach to quality assurance with change in documented performance of the cancer prevention activities.