Otero-Sabogal Regina, Owens Desi, Canchola Jesse, Tabnak Farzaneh
Institute for Health and Aging, University of California, San Francisco, Laurel Heights Campus, San Francisco, CA 94143-0646, USA.
J Community Health. 2006 Dec;31(6):497-519. doi: 10.1007/s10900-006-9027-3.
Community clinics provide inadequate breast cancer screening services to low-income, racially- and ethnically-diverse communities. This study develops and evaluates the effectiveness of multifaceted organizational system interventions--operational assessments, tracking systems, reminder calls, tailored education, physician prompts and a tailored counseling call--on mammography rescreening rates within three community clinics. We used the Chronic Care Model and Put Prevention Into Practice framework to redesign breast screening delivery services within the California Cancer Detection Programs: Every Woman Counts (CDP:EWC), community clinic settings. We used a quasi-experimental design with a random selection of 400 patients at pre-intervention. To establish a post-intervention clinic's rescreening rate a new comparable cross-sectional random sample of 347 women was drawn. Measures A chart abstraction instrument was used to establish clinics' rescreening rates. Subjects participants at pre and post-intervention were low-income women 50 years of age and older who had received normal mammography results and had not been diagnosed with breast cancer in the last five years. General linear mixed model analysis revealed significant improvements for the organizational system redesign condition [pre-intervention rescreening rate: 32.1 percent v. post-intervention rescreening rate 50.2 percent, (p < .001)]. For the organizational system redesign plus tailored counseling call condition, there was maintenance in the rescreening rate following the intervention [pre-intervention: 44.4 percent v. post-intervention: 45.1 percent, (p > 0.05)]. Multilevel interventions directed at redesigning community clinics primary care breast cancer screening services, can improve mammography rescreening rates.
社区诊所为低收入、种族和民族多样化的社区提供的乳腺癌筛查服务不足。本研究开发并评估了多方面的组织系统干预措施——运营评估、跟踪系统、提醒电话、量身定制的教育、医生提示以及一次量身定制的咨询电话——对三家社区诊所内乳房X光复查率的有效性。我们使用慢性病护理模型和将预防付之实践框架，在加利福尼亚癌症检测项目：关爱每一位女性（CDP:EWC）的社区诊所环境中重新设计乳腺癌筛查服务。我们采用了准实验设计，在干预前随机选择了400名患者。为了确定干预后诊所的复查率，抽取了一个新的由347名女性组成的可比横断面随机样本。测量方法 使用一份图表摘要工具来确定诊所的复查率。干预前后的受试者为年龄在50岁及以上的低收入女性，她们的乳房X光检查结果正常，且在过去五年中未被诊断出患有乳腺癌。广义线性混合模型分析显示，组织系统重新设计情况有显著改善[干预前复查率：32.1%对干预后复查率50.2%，（p <.001）]。对于组织系统重新设计加量身定制咨询电话的情况，干预后复查率保持不变[干预前：44.4%对干预后：45.1%，（p > 0.05）]。针对重新设计社区诊所初级保健乳腺癌筛查服务的多层次干预措施，可以提高乳房X光复查率。
