This project will test the impact and measure the costs of a prevention case manager (PCM) to improve cancer early detection provided to ethnically diverse women age 50-69 years seen in community health centers in the New York City area. Patients of four community health centers will be randomly assigned to usual care or the PCM intervention. The conceptual framework for the project is provided by the PRECEDE model. Evidence-based statements of the National Cancer Institute's CancerNet identify appropriate intervals for mammography, Pap and fecal occult blood testing, and sigmoidoscopy. Project Aims are: 1. To learn of barriers faced by this population in obtaining indicated services; 2. To assess at baseline the office environment and work processes in each participating center; 3. To develop and implement the PCM intervention to help patients overcome barriers; 4. To evaluate the impact and costs of the PCM in a randomized controlled efficacy trial. Phase I of the project involving Aims 1 and 2 will provide a baseline assessment of patient barriers and center environments. Aim 1 will be achieved through interviewing up to 50 systematically selected women in each center to learn about barriers to preventive care. Aim 2 will be addressed through questionnaires and guided discussions with clinical support staff in each center. Phase II concerns Aim 3, to refine the intervention informed by results of Phase I. The Intervention includes identification of patients who are overdue for services, culturally appropriate patient advice, assistance in overcoming barriers to care and follow-up monitoring to assist in resolution of abnormal test results. Phase III concerns Aim 4 conducting the efficacy trial. Outcome evaluation based on record review will compare the preventive status of patient cohorts between baseline and follow- up across the two study groups taking into account the work-up status of any abnormal test results with an evaluation cohort of 1400 women age 50-69 years. Process evaluation will allow accurate assessment of intervention costs, as well as observations of the practice environments and the process of providing preventive care. As a result of this project, a new model of enhancing preventive care for special populations will be tested and its efficacy and costs determined.
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