Manfredi C, Czaja R, Freels S, Trubitt M, Warnecke R, Lacey L
Health Research and Policy Centers, School of Public Health, University of Illinois at Chicago, USA.
Arch Fam Med. 1998 Jul-Aug;7(4):329-37. doi: 10.1001/archfami.7.4.329.
To evaluate a health maintenance organization (HMO)-sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations.
A randomized controlled trial with preintervention and postintervention measurements. Measurements were obtained by abstracting information from independent random samples of medical charts (N = 2316 at preintervention and 2238 at postintervention).
Forty-seven primary care physician practices located in low-income and minority urban neighborhoods in Chicago, Ill.
Practices were encouraged to adopt an office chart reminder system and to use a patient health maintenance card. Activities to facilitate the adoption of these items and for compliance with cancer screening guidelines included on-site training and start-up assistance visits, a physician continuing medical education seminar, and quality assurance visits with feedback to physicians.
The proportions of patients with a chart-documented mammogram, clinical breast examination, Papanicolaou smear, or fecal occult blood slide test in the 2 years before preintervention and postintervention chart abstractions.
Between baseline and postintervention, there was a net increase in the proportion of HMO members in the intervention, compared with the control practices, who received in the preceding 2 years a Papanicolaou smear (11.9%) and a fecal occult blood slide test (14.1%). There was a net increase in the proportion of non-HMO patients in the intervention compared with the control practices who received a clinical breast examination (15.3%) and a fecal occult blood slide test (20.2%).
Implementation of an HMO-mediated, multicomponent intervention to improve cancer screening was feasible and effective for the Papanicolaou smear, fecal occult blood slide test, and the clinical breast examination, but not for mammography.
评估由健康维护组织（HMO）发起的一项干预措施，以改善为低收入少数族裔人群服务的私人医生诊所的癌症筛查情况。
一项采用干预前和干预后测量的随机对照试验。测量通过从独立随机抽取的病历样本中提取信息获得（干预前N = 2316，干预后N = 2238）。
位于伊利诺伊州芝加哥市低收入少数族裔城市社区的47家初级保健医生诊所。
鼓励诊所采用办公图表提醒系统并使用患者健康维护卡。促进采用这些措施并遵守癌症筛查指南的活动包括现场培训和启动协助访问、医生继续医学教育研讨会以及向医生反馈的质量保证访问。
在干预前和干预后病历摘要的2年中，有图表记录的乳房X光检查、临床乳房检查、巴氏涂片检查或粪便潜血玻片检查的患者比例。
与对照诊所相比，干预组中HMO成员在干预前后，在前2年接受巴氏涂片检查（11.9%）和粪便潜血玻片检查（14.1%）的比例有净增加。与对照诊所相比，干预组中非HMO患者接受临床乳房检查（15.3%）和粪便潜血玻片检查（20.2%）的比例有净增加。
实施由HMO介导的多组分干预措施以改善癌症筛查，对于巴氏涂片检查、粪便潜血玻片检查和临床乳房检查是可行且有效的，但对乳房X光检查无效。
