A COMMUNITY INTERVENTION TO PROMOTE CANCER SCREENING

少数种族和少数民族、社会经济地位较低的人和保险不足的人的癌症筛查率特别低。该项目将实施和测试一种简单、具有成本效益的办公室干预措施，以提高弱势群体的癌症筛查率。干预策略利用办公室系统的方法，旨在最大限度地提高癌症筛查在常规初级保健访问。办公室干预包括一个低成本的材料包和明确的责任，病人和办公室工作人员，将帮助提供者进行机会性筛查。向提供者反馈筛查率是旨在维持干预效果的干预措施的第二个组成部分。 这项干预措施将在一项为期4年的准实验性试验中进行测试，该试验涉及16个初级保健诊所，这些诊所为坦帕、佛罗里达和周边县的主要弱势群体提供服务。我们假设，参加干预诊所的患者将更有可能接受癌症筛查服务（巴氏涂片，乳房X光检查，粪便潜血检测）比那些参加对照网站。我们亦会探讨干预策略的相对成本效益，以及干预效果的持久性。该项目利用了为癌症筛查存在缺陷的人群提供服务的临床站点。它还针对患者不接受癌症筛查服务的最常见原因（医生不推荐）。最后，干预措施利用大多数患者可获得的资源（初级保健诊所及其工作人员），并依靠低成本的方法来促进筛查。这些因素大大增加了成功的干预措施扩散到标准医疗护理的可能性。

ABSTACT=Racial and ethnic minorities, persons of lower socioeconomic status, and the underinsured have especially low rates of cancer screening. This project will implement and test a simple, cost-effective office intervention to increase cancer screening rates among disadvantaged populations. The intervention strategy utilizes an office system approach designed to maximize cancer screening during routine primary care visits. The office intervention consists of a low-cost kit of materials and explicit responsibilities for patients and office staffs that will help providers perform opportunistic screening. Feedback of screening rates to providers is a second component of the intervention designed to maintain intervention effects. The intervention will be tested in a 4-year quasi-experimental trial involving 16 primary care clinics that serve predominately disadvantaged populations in Tampa, Florida and the surrounding county. We hypothesize that patients attending intervention clinics will be more likely to receive cancer screening services (Pap smears, mammograms, fecal occult blood testing) than those attending control sites. We will also explore the relative cost-effectiveness of the intervention strategy and the durability of intervention effects over time. This project takes advantage of clinical sites serving populations with demonstrated deficits in cancer screening. It also targets the most common reason patients give for not receiving cancer screening services (physicians didn't recommend it). Finally, the intervention utilizes resources that are available to most patients (primary care clinics and their personnel), and relies on low cost methods to promote screening. These factors greatly increase the likelihood that a successful intervention can diffuse into standard medical care.