Systems Strategies to Support Cancer Screening in US Primary Care Practice

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 12/2011; 20(12):2471-9. DOI: 10.1158/1055-9965.EPI-11-0783
Source: PubMed


Although systems strategies are effective in improving health care delivery, little is known about their use for cancer screening in U.S. primary care practice.
We assessed primary care physicians' (N = 2,475) use of systems strategies for breast, cervical, and colorectal cancer (CRC) screening in a national survey conducted in 2007. Systems strategies included patient and physician screening reminders, performance reports of screening rates, electronic medical records, implementation of in-practice guidelines, and use of nurse practitioners/physician assistants. We evaluated use of both patient and physician screening reminders with other strategies in separate models by screening type, adjusted for the effects of physician and practice characteristics with multivariate logistic regression.
Fewer than 10% of physicians used a comprehensive set of systems strategies to support cancer screening; use was greater for mammography and Pap testing than for CRC screening. In adjusted analyses, performance reports of cancer screening rates, medical record type, and in-practice guidelines were associated with use of both patient and physician screening reminders for mammography, Pap testing, and CRC screening (P < 0.05).
Despite evidence supporting use of systems strategies in primary care, few physicians report using a comprehensive set of strategies to support cancer screening.
Current health policy initiatives underscore the importance of increased implementation of systems strategies in primary care to improve the use and quality of cancer screening in the United States.

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    • "Eby, 1998; D. K. Eby, 2007). SCF is an urban, tribally owned and operated health center that provides prepaid primary care 2011; Lee, Groessl, Ganiats, & Ho, 2011; Naylor, Ward, & Polite, 2012; Redwood et al., 2011; Sarfaty et al., 2012; Sequist, Zaslavsky, Marshall, Fletcher, & Ayanian, 2009; Yabroff et al., 2011). Computerized reminders and other HCT have been shown to improve healthcare delivery in a subset of patients with specific health conditions and to assist providers with panel management, such as tracking patient outcomes by provider and monitoring the usage and delivery of screening services. "

    Full-text · Article · Dec 2015
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    • "Apart from efforts to improve guideline adherence of the providers, several other interventions focused on patients have been investigated in the past two decades.13 The interventions to improve screening rates are adjuvant to strategies for reducing the risk factors for HPV infection.14 "
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    ABSTRACT: Objectives We previously developed and reported on a prototype clinical decision support system (CDSS) for cervical cancer screening. However, the system is complex as it is based on multiple guidelines and free-text processing. Therefore, the system is susceptible to failures. This report describes a formative evaluation of the system, which is a necessary step to ensure deployment readiness of the system. Materials and methods Care providers who are potential end-users of the CDSS were invited to provide their recommendations for a random set of patients that represented diverse decision scenarios. The recommendations of the care providers and those generated by the CDSS were compared. Mismatched recommendations were reviewed by two independent experts. Results A total of 25 users participated in this study and provided recommendations for 175 cases. The CDSS had an accuracy of 87% and 12 types of CDSS errors were identified, which were mainly due to deficiencies in the system's guideline rules. When the deficiencies were rectified, the CDSS generated optimal recommendations for all failure cases, except one with incomplete documentation. Discussion and conclusions The crowd-sourcing approach for construction of the reference set, coupled with the expert review of mismatched recommendations, facilitated an effective evaluation and enhancement of the system, by identifying decision scenarios that were missed by the system's developers. The described methodology will be useful for other researchers who seek rapidly to evaluate and enhance the deployment readiness of complex decision support systems.
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