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.
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