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Med Care. 2008 Sep;46(9 Suppl 1):S109-16. doi: 10.1097/MLR.0b013e31817d3fcf.

A provider intervention to improve colorectal cancer screening in county health centers.

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Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York 11797-8036, USA.



Publicly-funded health centers serve disadvantaged populations who underuse colorectal cancer screening (CRC). Because physicians play a key role in patient adherence to screening, provider interventions within health center practices could improve the delivery/utilization of CRC screening.


A 2-group study design was used with 4 pairs of health centers randomized to the intervention or control condition. The provider intervention featured academic detailing of the small practice groups, followed by a strategic planning session with the entire health center staff using SWOT analysis. The outcome measure of provider endoscopy referral/fecal occult blood test dispensing and/or completion of CRC screening was determined by medical record audit (n = 2224). The intervention effect was evaluated using generalized estimating equations. Pre-post intervention patient surveys (n = 281) were conducted.


Chart audits of the 1 year period before and after the intervention revealed a 16% increase from baseline in CRC screening referral/dispensing/completion among intervention centers, compared with a 4% increase among controls, odds ratio (OR) = 2.25 (1.67-3.04) P < 0.001. Intervention versus control health center patient self-reports of lack of physician recommendation as a reason for not having CRC screening declined from baseline to follow-up (P = 0.04).


Provider referrals/dispensing/completion of CRC screening within health centers was significantly improved and barriers reduced through a provider intervention combining continuing medical education with a team building strategic planning exercise.

[Indexed for MEDLINE]

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