Organizational Change: A Way to Increase Colon, Breast and Cervical Cancer Screening in Primary Care Practices

被引:20
作者
Arroyave, Ana Maria [1 ,2 ]
Penaranda, Eribeth K. [3 ]
Lewis, Carmen L. [4 ]
机构
[1] Texas Tech Univ, Hlth Sci Ctr, Dept Family & Community Med, Dept Med Educ,Paul L Foster Sch Med, El Paso, TX 79905 USA
[2] Univ N Carolina, Dept Social Med, Chapel Hill, NC USA
[3] Texas Tech Univ, Hlth Sci Ctr, Dept Family & Community Med, Paul L Foster Sch Med, El Paso, TX 79902 USA
[4] Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Dept Internal Med & Clin Epidemiol, Chapel Hill, NC 27599 USA
关键词
Cancer screening; Primary care; Organizational change; Secondary prevention; Practice improvement; RANDOMIZED CONTROLLED-TRIAL; SERVICES; SYSTEM; INTERVENTIONS; PREVENTION;
D O I
10.1007/s10900-010-9309-7
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
100404 [儿少卫生与妇幼保健学];
摘要
Screening tests for colon, cervical and breast cancer remain underutilized despite their proven effectiveness in reducing morbidity and mortality. Stone et al. concluded that cancer screening is most likely to improve when a health organization supports performance through organizational changes (OC) in staffing and clinical procedures. OC interventions include the use of separate clinics devoted to prevention, use of a planned care visit, designation of non-physician staff for specific prevention activities and continuous quality improvement interventions. Objectives To identify specific elements of OC interventions that increases the selected cancer screening rates. To determine to which extent practices bought into the interventions. Methods Eleven randomized controlled trials from January 1990 to June 2010 that instituted OC to increase cancer screening completion were included. Qualitative data was analyzed by using a framework to facilitate abstraction of information. For quantitative data, an outcome of measure was determined by the change in the proportion of eligible individuals receiving cancer screening services between intervention and control practices. The health prevention clinic intervention demonstrated a large increase (47%) in the proportion of completed fecal occult blood test; having a non-physician staff demonstrated an increase in mammography (18.4%); and clinical breast examination (13.7%); the planned care visit for prevention intervention increased mammography (8.8%); continuous quality improvement interventions showed mixed results, from an increase in performance of mammography 19%, clinical breast examination (13%); Pap smear (15%) and fecal occult blood test (13%), to none or negative change in the proportion of cancer screening rates. Conclusions To increase cancer screening completion goals, OC interventions should be implemented tailored to the primary care practice style. Interventions that circumvent the physicians were more effective. We could not conclude whether or not continuous quality techniques were effective. Further research is needed to evaluate cost-effectiveness of these interventions.
引用
收藏
页码:281 / 288
页数:8
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