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01-10-2016 | Original Research

Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

Authors: Marilyn M. Schapira, MD, MPH, Brian L. Sprague, PhD, Carrie N. Klabunde, PhD, Anna N. A. Tosteson, ScD, Asaf Bitton, MD, MPH, Jane S. Chen, ScB, Elisabeth F. Beaber, PhD, MPH, Tracy Onega, PhD, MA, MS, Charles D. MacLean, MD, Kimberly Harris, MM, Kathleen Howe, AA, Loretta Pearson, MPhil, Sarah Feldman, MD, MPH, Phyllis Brawarsky, MPH, Jennifer S. Haas, MD, MSc, on behalf of the PROSPR consortium

Published in: Journal of General Internal Medicine | Issue 10/2016

Abstract

Background

Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known.

Objective

To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH).

Design

Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening.

Participants

Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers.

Main Measures

The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up.

Key Results

There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guideline-adherent breast (OR 3.23, 95 % CI 1.58–6.61) or cervical (OR 2.56, 95 % CI 1.32–4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 % CI 1.15–41.7) or cervical (OR. 2.56, 95 % CI 1.26–5.26) cancer screening.

Conclusions

Providers lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline-adherent cancer screening in primary care settings.

Available only for authorised users

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Title: Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice
Authors: Marilyn M. Schapira, MD, MPH
Brian L. Sprague, PhD
Carrie N. Klabunde, PhD
Anna N. A. Tosteson, ScD
Asaf Bitton, MD, MPH
Jane S. Chen, ScB
Elisabeth F. Beaber, PhD, MPH
Tracy Onega, PhD, MA, MS
Charles D. MacLean, MD
Kimberly Harris, MM
Kathleen Howe, AA
Loretta Pearson, MPhil
Sarah Feldman, MD, MPH
Phyllis Brawarsky, MPH
Jennifer S. Haas, MD, MSc
on behalf of the PROSPR consortium
Publication date: 01-10-2016
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 10/2016
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-016-3726-y

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Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

Abstract

Background

Objective

Design

Participants

Main Measures

Key Results

Conclusions

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Conclusions

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