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Organizational Factors and the Cancer Screening Process

Organizational Factors and the Cancer Screening Process Abstract Cancer screening is a process of care consisting of several steps and interfaces. This article reviews what is known about the association between organizational factors and cancer screening rates and examines how organizational strategies can address the steps and interfaces of cancer screening in the context of both intraorganizational and interorganizational processes. We reviewed 79 studies assessing the relationship between organizational factors and cancer screening. Screening rates are largely driven by strategies to 1) limit the number of interfaces across organizational boundaries; 2) recruit patients, promote referrals, and facilitate appointment scheduling; and 3) promote continuous patient care. Optimal screening rates can be achieved when health-care organizations tailor strategies to the steps and interfaces in the cancer screening process that are most critical for their organizations, the providers who work within them, and the patients they serve. Cancer screening is effective at reducing morbidity and mortality from breast, cervical, and colorectal cancers (1–4). Screening is a process of care (5), consisting of several steps and interfaces between patients, providers, and health-care organizations. Interruptions, or “breakdowns,” in the screening process can lead to failure to detect and diagnose cancer promptly (6,7). Approximately half of women aged 50 and older who are diagnosed with late-stage breast cancer have not received a screening mammogram (8), and approximately half of cervical cancers are diagnosed among women who have not been screened in the past 3 years or ever (9). Nonadherence to recommended periodic screening is also an important attributable factor in colorectal cancer mortality, particularly among lower socioeconomic populations (10). Steps and interfaces in the cancer screening process range from patient recruitment to results reporting (Figure 1) and may vary by screening modality (ie, fecal occult blood test [FOBT] vs colonoscopy) and from organization to organization. Screening processes may be divided into two primary categories, represented by the upper and lower branches of Figure 1. The upper branch illustrates screening offered within an organization at the time of a health-care visit, whereas the lower branch illustrates screening offered by referral to another health-care provider or organization. The former category requires “intraorganizational” coordination of screening activities, whereas the latter requires “interorganizational” coordination across departmental or organizational boundaries, necessarily resulting in more interfaces and increasing challenges to communication and coordination. Figure 1. Open in new tabDownload slide Steps and interfaces in the cancer screening process. Figure 1. Open in new tabDownload slide Steps and interfaces in the cancer screening process. Papanicolaou testing for cervical cancer is most often performed as part of an intraorganizational process; mammography, sigmoidoscopy, and colonoscopy are more likely to occur in interorganizational processes, as most primary care practices do not have the facilities, equipment, or trained professionals to perform them (11). FOBTs, which have faded in popularity over the last decade (12), can be self-administered by patients, thereby escaping intraorganizational or interorganizational processes. However, communication and coordination still are required between providers and patients, and between patients and the organizations to which they must return completed tests. Organizational changes have been shown to have a major impact on rates of breast, cervical, and colorectal cancers screening (13). Few studies explore the role of organizational factors in addressing the interfaces presented by intra- and interorganizational screening processes, however. This article reviews what is known about the association between organizational factors and cancer screening rates and examines how organizational strategies can address the steps and interfaces of cancer screening in the context of both intraorganizational and interorganizational processes. Methods Definitions “Steps” in the cancer screening process are medical encounters or actions, including patient recruitment, attendance at a health-care visit, and performance of a screening test (14) (Figure 1). “Interfaces” are transfers of information and/or responsibility between patients, providers, and health-care organizations, including provider recommendation or referral to screening, appointment scheduling, and results reporting. Interfaces are not only within and between organizations but also between organizations and providers, organizations and patients, and patients and providers. We use the term “health-care organization” to refer to entities that provide, coordinate, or refer patients to cancer screening. This definition includes primary care practices, community health clinics, hospitals, and health maintenance organizations, for example, but excludes faith-based organizations or community groups involved in cancer screening promotion or population-level registries used to identify patients in need of screening. Organizational factors affecting both intraorganizational and interorganizational cancer screening include “structures,” such as capital or human resources and administrative or fiscal arrangements (15), and “processes,” activities done to and for patients within these structures (16). Organizational structures and processes can be designed to overcome interface challenges between and among health-care organizations, providers, and patients. We classify organizational factors according to 1) which steps and interfaces they address within the screening process; 2) their target audience (patients and/or health-care providers); and 3) the mechanism through which they change screening behaviors (predisposing, enabling, or reinforcing, per the Precede/Proceed model) (Figure 2) (17). This classification acknowledges that screening is the result of interactions between provider and patient behaviors that occur within organizational contexts. Figure 2. Open in new tabDownload slide Classification of organizational interventions by cancer screening steps or interfaces, target audience, and mechanism. Figure 2. Open in new tabDownload slide Classification of organizational interventions by cancer screening steps or interfaces, target audience, and mechanism. “Predisposing factors,” such as knowledge, attitudes, perceptions, or beliefs, provide rationale or motivation for behavior. Strategies aimed at positively predisposing patients include counseling or educational materials. Strategies aimed at positively predisposing providers may involve continuing education regarding current evidence-based guidelines, for example. “Enabling factors,” such as skills, resources, and technology, facilitate patient or provider behaviors. Organizational strategies that enable providers include clinical information systems, such as reminders and delivery system design, including care coordination and management via clinician teams. For patients, enabling strategies include logistical assistance, such as access to convenient transportation and appointment scheduling. “Reinforcing factors” provide a continuing encouragement, reward, or incentive for behaviors. For example, pay-for-performance initiatives that provide financial rewards for meeting screening targets act as reinforcement for providers. Strategies aimed at reinforcing repeat screening among patients who have screened in the recent past include anniversary reminder mailings, for example. Literature Search We conducted a selective search to identify studies that assessed the association between organizational structures and processes and cancer screening rates. To identify rigorous evaluations of interventions to promote cancer screening occurring within health-care organizations, we gathered references from systematic reviews of interventions to promote screening published in 2008 (18–20) and updated in 2009 (21). Fifty-nine of the referenced articles described interventions occurring within health-care organizations from 1990 through 2008 and were retained for review. To describe the relationship between organizational structure and process factors and cancer screening outside of the intervention context, we searched the MEDLINE database for English-language articles published from 1990 through 2008, applying the search terms “cancer screening“ and “organization” or “cancer screening” and “primary care” to the title and abstract fields. To locate articles not detected by the search terms, we electronically searched by author for articles by researchers whose previous published work explored organizational influences in cancer screening. We identified articles that may have been missed in electronic searches by manually reviewing references from bibliographies of articles from the initial search and from reviews of cancer screening interventions. These search techniques resulted in 20 nonintervention articles that assessed the relationship between organizational factors and cancer screening. Two of the authors (R. Anhang Price and H. Edwards) reviewed the primary articles, summarized the findings concerning screening outcomes, and identified the target audience (patient or provider), intervention mechanism (predisposing, enabling, or reinforcing), and cancer screening process or interface addressed (recruitment, visit with on-site screening, recommendation and/or referral, appointment scheduling, test performance, or results reporting). Discrepancies were resolved by discussion with all authors. Results Of the 79 studies under review, 49 measured the association between organizational factors and breast cancer screening, 21 measured associations with cervical cancer screening, and 20 measured associations with colorectal cancer screening. Study settings varied considerably and included primary care practices, community health centers, local and national health plans, health maintenance organizations, and Department of Veterans Affairs medical centers. Patient populations included those who had never participated in screening, those who were up to date for screening, and patients with and without health insurance that provided coverage for screening tests. Study details are described in Appendix 1, Tables 1 and 2. Organizational Processes Evidence of the association between organizational processes and cancer screening outcomes is summarized in Table 1. Fifty of the studies we reviewed evaluated the effects of processes to promote patient recruitment; three evaluated visits with on-site screening; 23 provider recommendations or referrals to screening; 15 appointment scheduling; two provider or patient training to perform screening tests; and none reporting of screening test results. Two cross-cutting processes had the potential to influence multiple steps or interfaces by promoting continuity of patient care. Table 1. Evidence of association between organizational processes and breast, cervical, and colorectal cancer screening outcomes, by cancer screening step/interface, target audience, and behavioral mechanism* Cancer screening step or interface addressed Target audience Breast cancer screening Cervical cancer screening Colorectal cancer screening Behavioral mechanism Behavioral mechanism Behavioral mechanism Predisposing Enabling Reinforcing Predisposing Enabling Reinforcing Predisposing Enabling Reinforcing Recruitment Patient Reminder letter (untailored) (23,46,47,50,53,58,66,70,77), (29,45,65,71) Tailored mailing (31,47,65,75), (45,54,56,67,68,72,78) Tailored telephone counseling (31,33,50,55,56,60,68,70,74,75,77), (67,78) Tailored computer tutorial (32) Video (32) In-office educational materials (43) In-office counseling (75) Group education (35) Patient minirecord (36) Reminder letter (untailored) (24,27,65) Tailored mailing (31,65), (56,67,72) Tailored telephone counseling (31,33,56), (67) Reminder letter (untailored) (26,47,64,77), (28,30,45) Tailored mailing (45,47,67), (54) Telephone call (26) Tailored telephone counseling (67,77) In-office video (79) Patient minirecord (36) Tailored mailing  (67) Tailored telephone counseling (67) Reminder letter (untailored) (49,61,76) FOBT kit request card (42,62) Reminder call (61,76) FOBT kit (49,57,62,63) FOBT kits with postage-paid return (38,58) Patient minirecord (36) Visit with on-site screening Patient Same-day mammography (37) Free, on-site mammography (53,80) Recommendation and/or referral Provider Physician education (33) Chart reminder (40,52,66,73), (23,29,83) Flow sheet (83) Patient minirecord (36) Nurse completion of referral forms (43) Audit and feedback (39,48), (44) Financial incentives (40,44,69,92,99) Chart reminder (26,64,73), (30) Patient minirecord (36) Audit and feedback (39,48), (44) Financial incentives (69,99), (44) Directive prioritizing screening (25) Chart reminder (76,88) Patient minirecord (36) Audit and feedback (48),(44) Financial incentives (22),(44) Patient Referral tear sheet (41) Appointment scheduling Patient Letter with appointment time (46) Letter with direct access to appointment (no referral) (52,73), (71) Scheduling telephone call (24,27,34,54,58,60,74,77) Letter with appointment time (64) Letter with direct access to appointment (no referral) (73) Scheduling telephone call (54) Test performance Provider Physician education (33) Patient Instructional telephone call (61) Cancer screening step or interface addressed Target audience Breast cancer screening Cervical cancer screening Colorectal cancer screening Behavioral mechanism Behavioral mechanism Behavioral mechanism Predisposing Enabling Reinforcing Predisposing Enabling Reinforcing Predisposing Enabling Reinforcing Recruitment Patient Reminder letter (untailored) (23,46,47,50,53,58,66,70,77), (29,45,65,71) Tailored mailing (31,47,65,75), (45,54,56,67,68,72,78) Tailored telephone counseling (31,33,50,55,56,60,68,70,74,75,77), (67,78) Tailored computer tutorial (32) Video (32) In-office educational materials (43) In-office counseling (75) Group education (35) Patient minirecord (36) Reminder letter (untailored) (24,27,65) Tailored mailing (31,65), (56,67,72) Tailored telephone counseling (31,33,56), (67) Reminder letter (untailored) (26,47,64,77), (28,30,45) Tailored mailing (45,47,67), (54) Telephone call (26) Tailored telephone counseling (67,77) In-office video (79) Patient minirecord (36) Tailored mailing  (67) Tailored telephone counseling (67) Reminder letter (untailored) (49,61,76) FOBT kit request card (42,62) Reminder call (61,76) FOBT kit (49,57,62,63) FOBT kits with postage-paid return (38,58) Patient minirecord (36) Visit with on-site screening Patient Same-day mammography (37) Free, on-site mammography (53,80) Recommendation and/or referral Provider Physician education (33) Chart reminder (40,52,66,73), (23,29,83) Flow sheet (83) Patient minirecord (36) Nurse completion of referral forms (43) Audit and feedback (39,48), (44) Financial incentives (40,44,69,92,99) Chart reminder (26,64,73), (30) Patient minirecord (36) Audit and feedback (39,48), (44) Financial incentives (69,99), (44) Directive prioritizing screening (25) Chart reminder (76,88) Patient minirecord (36) Audit and feedback (48),(44) Financial incentives (22),(44) Patient Referral tear sheet (41) Appointment scheduling Patient Letter with appointment time (46) Letter with direct access to appointment (no referral) (52,73), (71) Scheduling telephone call (24,27,34,54,58,60,74,77) Letter with appointment time (64) Letter with direct access to appointment (no referral) (73) Scheduling telephone call (54) Test performance Provider Physician education (33) Patient Instructional telephone call (61) * Bolded citations indicate a significant association between the organizational variable and cancer screening. Italicized citations indicate no association. In some cases, associations are negative. Jibaja-Weiss, Volk, Kingery, Smith and Holcomb (47) found a negative association between tailored letters and Papanicolaou test and mammography participation; Wee, Phillips, Burstin, et al. (99) found a negative association between provider productivity incentives and Papanicolaou test provision. FOBT = fecal occult blood test Open in new tab Table 1. Evidence of association between organizational processes and breast, cervical, and colorectal cancer screening outcomes, by cancer screening step/interface, target audience, and behavioral mechanism* Cancer screening step or interface addressed Target audience Breast cancer screening Cervical cancer screening Colorectal cancer screening Behavioral mechanism Behavioral mechanism Behavioral mechanism Predisposing Enabling Reinforcing Predisposing Enabling Reinforcing Predisposing Enabling Reinforcing Recruitment Patient Reminder letter (untailored) (23,46,47,50,53,58,66,70,77), (29,45,65,71) Tailored mailing (31,47,65,75), (45,54,56,67,68,72,78) Tailored telephone counseling (31,33,50,55,56,60,68,70,74,75,77), (67,78) Tailored computer tutorial (32) Video (32) In-office educational materials (43) In-office counseling (75) Group education (35) Patient minirecord (36) Reminder letter (untailored) (24,27,65) Tailored mailing (31,65), (56,67,72) Tailored telephone counseling (31,33,56), (67) Reminder letter (untailored) (26,47,64,77), (28,30,45) Tailored mailing (45,47,67), (54) Telephone call (26) Tailored telephone counseling (67,77) In-office video (79) Patient minirecord (36) Tailored mailing  (67) Tailored telephone counseling (67) Reminder letter (untailored) (49,61,76) FOBT kit request card (42,62) Reminder call (61,76) FOBT kit (49,57,62,63) FOBT kits with postage-paid return (38,58) Patient minirecord (36) Visit with on-site screening Patient Same-day mammography (37) Free, on-site mammography (53,80) Recommendation and/or referral Provider Physician education (33) Chart reminder (40,52,66,73), (23,29,83) Flow sheet (83) Patient minirecord (36) Nurse completion of referral forms (43) Audit and feedback (39,48), (44) Financial incentives (40,44,69,92,99) Chart reminder (26,64,73), (30) Patient minirecord (36) Audit and feedback (39,48), (44) Financial incentives (69,99), (44) Directive prioritizing screening (25) Chart reminder (76,88) Patient minirecord (36) Audit and feedback (48),(44) Financial incentives (22),(44) Patient Referral tear sheet (41) Appointment scheduling Patient Letter with appointment time (46) Letter with direct access to appointment (no referral) (52,73), (71) Scheduling telephone call (24,27,34,54,58,60,74,77) Letter with appointment time (64) Letter with direct access to appointment (no referral) (73) Scheduling telephone call (54) Test performance Provider Physician education (33) Patient Instructional telephone call (61) Cancer screening step or interface addressed Target audience Breast cancer screening Cervical cancer screening Colorectal cancer screening Behavioral mechanism Behavioral mechanism Behavioral mechanism Predisposing Enabling Reinforcing Predisposing Enabling Reinforcing Predisposing Enabling Reinforcing Recruitment Patient Reminder letter (untailored) (23,46,47,50,53,58,66,70,77), (29,45,65,71) Tailored mailing (31,47,65,75), (45,54,56,67,68,72,78) Tailored telephone counseling (31,33,50,55,56,60,68,70,74,75,77), (67,78) Tailored computer tutorial (32) Video (32) In-office educational materials (43) In-office counseling (75) Group education (35) Patient minirecord (36) Reminder letter (untailored) (24,27,65) Tailored mailing (31,65), (56,67,72) Tailored telephone counseling (31,33,56), (67) Reminder letter (untailored) (26,47,64,77), (28,30,45) Tailored mailing (45,47,67), (54) Telephone call (26) Tailored telephone counseling (67,77) In-office video (79) Patient minirecord (36) Tailored mailing  (67) Tailored telephone counseling (67) Reminder letter (untailored) (49,61,76) FOBT kit request card (42,62) Reminder call (61,76) FOBT kit (49,57,62,63) FOBT kits with postage-paid return (38,58) Patient minirecord (36) Visit with on-site screening Patient Same-day mammography (37) Free, on-site mammography (53,80) Recommendation and/or referral Provider Physician education (33) Chart reminder (40,52,66,73), (23,29,83) Flow sheet (83) Patient minirecord (36) Nurse completion of referral forms (43) Audit and feedback (39,48), (44) Financial incentives (40,44,69,92,99) Chart reminder (26,64,73), (30) Patient minirecord (36) Audit and feedback (39,48), (44) Financial incentives (69,99), (44) Directive prioritizing screening (25) Chart reminder (76,88) Patient minirecord (36) Audit and feedback (48),(44) Financial incentives (22),(44) Patient Referral tear sheet (41) Appointment scheduling Patient Letter with appointment time (46) Letter with direct access to appointment (no referral) (52,73), (71) Scheduling telephone call (24,27,34,54,58,60,74,77) Letter with appointment time (64) Letter with direct access to appointment (no referral) (73) Scheduling telephone call (54) Test performance Provider Physician education (33) Patient Instructional telephone call (61) * Bolded citations indicate a significant association between the organizational variable and cancer screening. Italicized citations indicate no association. In some cases, associations are negative. Jibaja-Weiss, Volk, Kingery, Smith and Holcomb (47) found a negative association between tailored letters and Papanicolaou test and mammography participation; Wee, Phillips, Burstin, et al. (99) found a negative association between provider productivity incentives and Papanicolaou test provision. FOBT = fecal occult blood test Open in new tab Recruitment. Standard reminder mailings effectively increased mammography and Papanicolaou test rates in several settings, including community health centers serving low-income women, health maintenance organizations, and general practices (23,26,46,47,50,53,58,64,66,70,77), but several other studies conducted in similar settings found standard letters to be no more effective than no letter (28–30,45,65,71). By providing a cue to action, standardized mailings act as predisposing interventions for patients who are up to date for screening or those who have intention to attend timely screening in the future. More intensive predisposing interventions, such as tailored communications, may be needed for patients who are not highly motivated to participate in screening. Tailored mailings or telephone counseling are customized according to patients’ logistical, cognitive, and affective barriers to screening; intention to participate in screening; past screening behaviors; and/or data available from medical records. There is mixed evidence for the effects of tailored mailings on screening rates; however, tailored telephone counseling has shown more consistently positive results for promotion of mammography. Distribution of FOBT request cards, FOBT kits, and FOBT kits with prepaid postage successfully increased rates of FOBT use in all interventions under study (38,42,49,57,58,62,63); these interventions enable screening by offering patients the tools to perform screening independently, thereby avoiding steps and interfaces of either intra- or interorganizational cancer screening. Visit With On-site Screening. Availability of on-site screening facilities and personnel can reduce the number of interfaces required to complete screening and enable patient participation by helping to overcome time-, cost-, and transportation-related barriers. Patients offered the opportunity to receive a mammogram nearby immediately after scheduled internal medicine appointments were significantly more likely to receive mammograms than those who were required to schedule a mammogram for a later date (37). Provision of free on-site screening at community health centers either in a bimonthly mammography van or a routinely available traditional mammography facility was also associated with increased screening participation among low-income women (53,80). Recommendation and/or Referral. Provider recommendation is strongly associated with patient screening behavior (101). Chart reminders, either electronic or paper prompts that remind clinicians that a patient is due for screening, were assessed by 10 studies under review. Positive associations were found for four of seven reminders of mammography (40,52,66,73), three of four reminders of Papanicolaou testing (26,64,73), and two of two reminders of colorectal cancer screening (76,88). Chart reminders have a more limited reach than recruitment strategies, as they enable screening only among those patients who attend a health-care visit or those who attend visits but fail to receive screening. Audit and feedback interventions consist of medical chart reviews for patients’ screening eligibility, referral and completion, and verbal or written feedback to clinicians regarding their compliance with screening guidelines. These interventions reinforce providers’ screening behaviors by underscoring the importance of screening and stimulating changes in screening practices, as needed. Two primary studies of audit and feedback among medical residents reported increases in referral to mammography or sigmoidoscopy and completion of Papanicolaou testing and/or FOBT (39,48). A third study of primary care physicians found no association between feedback and on-site screening for cervical cancer or referral to off-site breast or colorectal cancer screening (44). Productivity and quality incentive payments, sometimes referred to as “pay for performance,” have been proposed to reinforce clinician behaviors. However, little empirical evidence supports their effectiveness (102). In our review, the six studies evaluating financial incentives reported mixed results. Token rewards of less than $100 were not associated with increases in mammography referral among primary care physicians (40); similarly, small periodic bonuses offered to primary care practice sites based on compliance with breast, cervical, and colorectal cancers screening were ineffective (44), as were quarterly bonuses to multispecialty physician organizations (69). The latter study did find a positive association between bonuses and Papanicolaou test administration, however. Armour et al. (22) found that an end-of-year bonus for primary care physicians treating managed care patients was associated with increased referral to colorectal cancer screening, especially FOBT. Wee, Phillips, Burstin, et al. (99) found that patients of physicians paid by salary plus productivity incentives were significantly less likely to receive Papanicolaou tests than patients of physicians paid by salary only. Together, the findings of these studies suggest that financial incentives may be more influential when targeted to individual clinicians, rather than to physician groups, when they are large enough to be meaningful and noticeable to their recipients, and when the targeted behaviors do not require further interfaces of care (ie, appointment scheduling and/or administration of screening tests by an additional health-care provider at a later time, as in the cases of mammography or colonoscopy). Financial incentives, like all organizational strategies that enable or reinforce provider referral, may be more effective in achieving increased screening participation when screening is provided in an intraorganizational process, rather than an interorganizational one. Appointment Scheduling. Enabling appointment scheduling through telephone calls was associated with increases in mammography use in all eight studies that assessed this approach (24,27,34,54,58,60,74,77); an additional study found a positive relationship between scheduling telephone calls and use of Papanicolaou tests (54). Some of these telephone call interventions combined scheduling and tailored counseling; however, the scheduling component, rather than counseling, was likely the primary mechanism for improved patient screening in many instances [see, eg (34,74)]. Test Performance. Training can predispose or enable clinicians to recommend or conduct screening. Training or education that transmits screening data or recommendations may build the knowledge base that predisposes a clinician to recommend screening, whereas skills-based courses may enable providers to perform new or unfamiliar screening tests. Similarly, instruction can enable patients to perform self-tests like FOBT, when available. In our review, an educational curriculum for physicians emphasizing instruction in mammography counseling and clinical breast examination did not significantly alter patients’ mammography adherence, as most of the physicians under study participated in only part of the program (33). However, an instructional telephone call to patients regarding how to use FOBT kits was successful in promoting FOBT use (61). Results Reporting. No studies under review focused explicitly on enabling reporting of screening test results. Cross-cutting Organizational Processes. In addition to organizational processes designed to address specific steps and interfaces in cancer screening, our review identified processes aimed at improving continuity of care. Joint responsibility for patients across clinicians in a group practice—especially among those who have worked together over an extended tenure—was shown to facilitate improvements in breast and cervical cancer screening rates (94). Patient assignment to primary care providers in Department of Veterans Affairs medical centers was associated with improvements in breast cancer screening rates, but not cervical cancer screening rates (85). Organizational Structures Evidence of the association between selected organizational structures and cancer screening outcomes is summarized in Table 2. Like the cross-cutting organizational processes mentioned above, organizational structures have the potential to influence multiple steps and interfaces in cancer screening. Table 2. Evidence of association between selected organizational structures and breast, cervical, and colorectal cancer screening outcomes* Organizational structures Breast cancer screening Cervical cancer screening Colorectal cancer screening Practice size     Patient volume (92,97) (97), (92) (97,100)     Number of providers (94,85), (95) (94), (85) (95) Practice type     Academic vs community-based private practices vs health maintenance organizations (98)     Integrated medical group vs independent practice association (92) (92)     Multispecialty vs single specialty practice (86) Resources or facilities for screening (97) (97) (81,97,100), (86) Nonphysician personnel to identify screening-eligible patients (83) Staffing mix (ratio of generalists to specialists) (97) (97) (97,100) Organizational culture (perceived commitment to service quality) (85) (85) Organizational structures Breast cancer screening Cervical cancer screening Colorectal cancer screening Practice size     Patient volume (92,97) (97), (92) (97,100)     Number of providers (94,85), (95) (94), (85) (95) Practice type     Academic vs community-based private practices vs health maintenance organizations (98)     Integrated medical group vs independent practice association (92) (92)     Multispecialty vs single specialty practice (86) Resources or facilities for screening (97) (97) (81,97,100), (86) Nonphysician personnel to identify screening-eligible patients (83) Staffing mix (ratio of generalists to specialists) (97) (97) (97,100) Organizational culture (perceived commitment to service quality) (85) (85) * Bolded citations indicate a significant association between the organizational variable and cancer screening. Italicized citations indicate no association. In some cases, associations are negative. Soban and Yano (97) and Yano, Soban, Parkerton and Etzioni (100) found that higher patient volume is a negative predictor of cancer screening tests; Greiner, Engelman, Hall, and Ellerbeck (86) found that having no endoscopy available in the practice was significantly associated with patients’ self-report that they were up to date on colorectal cancer screening. Open in new tab Table 2. Evidence of association between selected organizational structures and breast, cervical, and colorectal cancer screening outcomes* Organizational structures Breast cancer screening Cervical cancer screening Colorectal cancer screening Practice size     Patient volume (92,97) (97), (92) (97,100)     Number of providers (94,85), (95) (94), (85) (95) Practice type     Academic vs community-based private practices vs health maintenance organizations (98)     Integrated medical group vs independent practice association (92) (92)     Multispecialty vs single specialty practice (86) Resources or facilities for screening (97) (97) (81,97,100), (86) Nonphysician personnel to identify screening-eligible patients (83) Staffing mix (ratio of generalists to specialists) (97) (97) (97,100) Organizational culture (perceived commitment to service quality) (85) (85) Organizational structures Breast cancer screening Cervical cancer screening Colorectal cancer screening Practice size     Patient volume (92,97) (97), (92) (97,100)     Number of providers (94,85), (95) (94), (85) (95) Practice type     Academic vs community-based private practices vs health maintenance organizations (98)     Integrated medical group vs independent practice association (92) (92)     Multispecialty vs single specialty practice (86) Resources or facilities for screening (97) (97) (81,97,100), (86) Nonphysician personnel to identify screening-eligible patients (83) Staffing mix (ratio of generalists to specialists) (97) (97) (97,100) Organizational culture (perceived commitment to service quality) (85) (85) * Bolded citations indicate a significant association between the organizational variable and cancer screening. Italicized citations indicate no association. In some cases, associations are negative. Soban and Yano (97) and Yano, Soban, Parkerton and Etzioni (100) found that higher patient volume is a negative predictor of cancer screening tests; Greiner, Engelman, Hall, and Ellerbeck (86) found that having no endoscopy available in the practice was significantly associated with patients’ self-report that they were up to date on colorectal cancer screening. Open in new tab A positive relationship between patient volume and clinical outcomes has been established for many procedures, including cancer surgeries (103,104), but provision of preventive care services may suffer in a high-volume practice environment (105). Our review found mixed evidence for the relationship between patient volume and cancer screening adherence. Studies of Department of Veterans Affairs medical centers and primary care practices found that higher patient volume was a strong negative predictor of breast, cervical, colorectal cancers screening (97,100), whereas a study of California physician groups found no relationship between patient volume and rates of cervical screening, and a positive relationship between volume and mammography rates (92). There are also conflicting findings for the association between the number of providers in a provider group—another measure of practice size—and screening rates. One study reported that physicians in group practice were no more or less likely to provide mammograms or colon cancer screening to Medicare beneficiaries than physicians in solo practice (95), whereas another study attributed higher rates of up-to-date colorectal screening in group or multispecialty practices to time to discuss screening, rather than to the screening capacity of group practices (86). The effects of organizational size and practice type may be mediated by the presence of care processes to promote screening, efforts to coordinate across health-care providers and organizational units, and the human and capital resources dedicated to screening. Availability of facilities and staff for screening has the potential to increase the likelihood that patients receive screening on-site. Our review found mixed results regarding this relationship. Studies of Department of Veterans Affairs medical centers and primary care practices reported that sufficiency of appropriately equipped examining and treatment rooms, equipment for pelvic exams, personal computers, and patient education space was associated with higher rates of cervical and colorectal cancer screening (97,100). A positive association was not found for breast cancer screening, however, perhaps because the screening resources assessed did not include mammography equipment (97). Availability of flexible sigmoidoscopy in family practices was shown by one study to be positively associated with increased likelihood of patients having up-to-date colorectal screening (81). A study of rural primary care practices did not find an association between availability of endoscopy in the practice and increased rates of screening (86), and attributed failure to screen to inadequate discussions between clinicians and patients. These findings suggest that facilities and equipment for screening can influence screening by allowing for intraorganizational screening, but that resources alone may be insufficient in the absence of efforts to promote patient recruitment, provider recommendation, and patient–provider communication. Nonphysician personnel to identify patients eligible for screening mammography was not found to be significantly associated with mammography rates in one study of primary care practices (83). Although administration of screening by nonphysician staff has been suggested to expand capacity, especially in the context of colorectal cancer screening (106), no studies in our review assessed the effects of assigning nonphysician personnel to perform screening. Discussion Given sparse data and mixed findings, we cannot make conclusive statements about the relationship between specific organizational factors and cancer screening outcomes. Nonetheless, we can infer a theme: Organizational structures, such as practice size and type, do not dictate screening rates for a given organization. Rather, screening rates are largely driven by strategies to 1) limit the number of interfaces across organizational boundaries; 2) recruit patients, promote referrals, and facilitate appointment scheduling; and 3) promote continuous patient care. Limiting Interfaces Through On-site Screening. Interorganizational screening processes, which require interfaces across departmental and organizational boundaries, are often challenged by incompatibility of information technology systems, loss of information during patient handoff, and limited financial reward for successful interorganizational transfers of information and responsibility. Whenever possible, strategies to promote on-site screening reduce the number of interfaces for organizations, health-care providers, and patients, and thereby increase the likelihood that patients are screened. For this reason, on-site, same-day screening mammography was among the most consistently effective organizational strategies in our review. Addressing Steps and Interfaces. A number of organizational strategies can influence steps and interfaces in both intra- and interorganizational screening processes. Stepped approaches to recruitment, beginning with inexpensive, standardized reminder letters for patients who are highly motivated to screen, and advancing, as needed, to tailored mailings or telephone counseling to predispose and reinforce patient screening, are well supported by the literature, and address the first interface in Figure 1. Such “outreach” reminders do not necessitate a provider–patient encounter. For patients who attend health-care visits, reminders to clinicians enable “inreach,” improved recommendation or referral to screening, as well. Strategies to reinforce provider screening referrals and recommendation, such as financial incentives, have been less effective than enabling interventions, such as chart reminders. Providing Continuous Care. Ensuring that patients pass through each of the necessary steps and interfaces requires strategies that address not only each step and interface individually but also emphasize continuous flow across the screening process. Studies in our review reported conflicting results for the relation between usual provider continuity, care of a patient by a single health-care provider or provider team over time, and breast and cervical cancer screening (84,89,93,94). Mixed findings are not surprising because continuity is not an inherent organizational feature, but rather the product of organizational structures and processes designed to ensure that patients do not get lost in interfaces with health-care providers and organizations. Continuity can be classified into three categories: 1) informational continuity, the use of information about patients’ histories and personal circumstances to make care decisions; 2) management continuity, the delivery of appropriate and timely health-care services that respond to patients’ changing needs; and 3) relational continuity, an ongoing therapeutic relationship between patients and their provider(s) (107). All three types of continuity may influence interface activities by affecting whether providers know a patient’s screening status, whether a patient is seen regularly and receives routine screening reminders, and whether a patient has an ongoing relationship with a health-care provider whose recommendations he or she trusts. A number of proven organizational strategies can address the types of continuity. For example, informational continuity can be fostered through consistent use of electronic medical records, management continuity through development and implementation of practice guidelines and protocols, and relational continuity through role assignments that free clinicians to see patients for longer visits (108). Applying Research Findings in Practice Identifying Organizational Priorities for Improving Screening Rates. Cancer screening may be promoted or impeded by factors at several levels, including characteristics of the patient; characteristics of the health-care provider and of the health-care team in which the provider works; the organization or practice setting in which the screening test takes place; and the larger health-care environment (14). Consequently, the success of organizational strategies to promote screening depends on characteristics of the organization, the providers who work within it, and the patients it serves. For example, predisposing strategies may be necessary for some providers and patients, but insufficient in the absence of enabling and reinforcing strategies. To select and prioritize strategies, organizations must assess their performance at each step and interface of the cancer screening process, and examine the causes of process breakdowns at the organizational-, provider-, and patient-level. Successful organizational strategies will vary by screening modality and for each organization, and must reflect interfaces across departments or organizational boundaries. Adapting Organizational Processes and Interventions for Implementation. Once priority screening steps and interfaces are identified, proven strategies must be tailored to the particular organization. Tailoring involves retention of the strategy's core components, such as counseling or appointment scheduling, and adaptation of peripheral elements, such as counseling messages or timing of appointments, to integrate the strategy into the organization's ongoing activities (109). Tailoring strategies based on assessments of practices’ clinical operations, culture, approaches to prevention, and relationships between personnel have been shown to increase cancer screening in primary care practice settings (110) and may be particularly useful for improving intraorganizational screening processes. Implementation of screening process improvements is influenced by factors both internal and external to the organization. These factors have been codified in a model of primary care practice change that considers interrelationships between motivation of key stakeholders, such as medical directors or others who influence the behavior of the clinical practice; resources for change, such as management infrastructure, communication, and leadership; outside “motivators,” such as events and systems in the community and health-care environment; and perceived opportunities to make changes (111). Stakeholder motivation stems from a belief in the importance and effectiveness of systems approaches to improve screening; however, many practice leaders and clinicians do not hold this belief (51). Consistent and committed leadership is required to help organizations overcome the resistance and disruptions that may result from process changes (112). Priorities for Future Research Our review identified more than 40 discrete organizational factors that may promote cancer screening, encompassing most of the commonly measured factors of health-care organizations (113). However, some important organizational features are notably absent in the cancer screening studies we reviewed. For example, both team effectiveness and quality reporting have been associated with organizational changes and processes that improve care quality, especially for chronic conditions [see, eg, (114,115)]. The ways in which organizations address competing demands of acute, chronic, and preventive care also substantially affect the likelihood that patients receive adequate preventive services (116). Organizational leaders’ commitment is also critical to pursuit of quality improvements (117). These concepts are worthy of further assessment in the context of cancer screening, as the comprehensive set of organizational factors shown to influence chronic and acute care may be relevant in the context of preventive care, as well (118). Few of the studies in our review examined the component steps and interfaces within organizations’ cancer screening processes or explicitly described the interdepartmental or interorganizational communication and coordination that needed to occur to accomplish cancer screening. Assessment of the intra- or interorganizational cancer screening process is a critical first phase for the development and implementation of effective organizational solutions and is a priority for future research. Development and application of measures that systematically describe organizational factors that influence screening steps and interfaces for both intra- and interorganizational processes would result in actionable findings for health-care organizations seeking to improve screening. Ideally, organizational strategies to improve screening should address ongoing cancer screening performance—that is, screening participation leading to appropriate follow-up among those with abnormal results and repeated routine screening among those with normal results (119). However, the vast majority of studies in our review measured single screening events. Future research should address the effectiveness of organizational factors to promote long-term screening that bridges the transition to diagnosis and treatment, as needed. Limitations Our review has a number of important limitations. First, the search terms and techniques we applied may have missed some relevant articles. In particular, we included only those intervention studies that met the rigorous inclusion criteria of the Task Force on Community Preventive Services (120). Second, we focused on organizational structures and processes associated with cancer screening. Much research has investigated the association between organizational factors and a variety of other health-care outcomes, most notably patient safety and chronic care delivery. A number of systematic measurement tools, including the Assessment of Chronic Illness Care, the Survey of Organizational Attributes for Primary Care, and clinical microsystem assessments, are available to evaluate organizational attributes and assess strengths and weaknesses in care delivery (121–123). This extensive body of work is beyond the scope of our review. Integration of cancer screening as a prevention outcome in this work is a critical priority, as is the development of systematic organizational approaches that span across different types of preventive care services (124). Third, much of the intervention literature we reviewed focused on improving mammography and FOBT participation; further research is needed on organizational factors to improve cervical and colorectal cancer screening, as the cancer screening process—and the organizational factors that influence it—varies by screening modality. Finally, as new screening tests emerge, existing tests grow in popularity, and clinical guidelines are updated, the cancer screening process must be reexamined to determine which steps and interfaces are most critical. Conclusions A variety of organizational strategies has the potential to improve cancer screening rates substantially by limiting the number of interfaces across organizational boundaries; recruiting patients, promoting referrals, and facilitating appointment scheduling; and promoting continuous patient care. Optimal screening can be achieved if health-care organizations tailor their organizational processes to the cancer screening steps and interfaces that are most critical for their organizations, the providers who work within them, and the patients they serve. Funding This project has been funded in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. We gratefully acknowledge the insightful comments of Mary Fennell and an anonymous reviewer. Appendix 1: Organizational Factors and the Cancer Screening Process Appendix Table 1. Description of organizational intervention studies* Reference Patient population Provider population or practice setting Intervention Armour et al. (22) Commercially insured patients aged 50 and older in a managed health-care plan Primary care physicians End-of-year bonus designed to increase colorectal cancer screening; bonus not described. Bankhead et al. (23) Women who had failed to attend a recent appointment for routine third-round breast screening General practices not meeting a target of 70% mammography coverage, United Kingdom Letters from physicians encouraging women to reconsider their decisions not to attend breast screening. Prompt in paper medical records for physicians to discuss breast screening at any routine consultation. Barr et al. (24) Women aged 50–75 who had had a previous mammogram, but not one within the previous 18 months Group model HMO, with most members privately insured Mail reminder indicating a mammogram was due and offering encouragement for the patient to call and schedule an appointment. Telephone call from medical center staff person containing the same information provided in the mailing and giving opportunity to schedule an appointment for clinical breast exam and mammogram referral. Battat et al. (25) VA patients Physicians practicing at VA hospitals Colorectal cancer screening chosen as a performance measure in a quality improvement initiative. Screening directive was issued and implemented (no further details given). Binstock et al. (26) Women aged 25–49 who had not had a Papanicolaou test in the past 3 years HMO with outpatient medical centers Telephone call and letter to patients. Patient chart reminder and memo to primary care provider. Bodiya et al. (27) Women aged 50 and older who had had a mammogram in the previous year and were due for the next annual screening Family practice Reminder letter to women. The letter plus telephone calls by medical assistants, who arranged mammograms and processed referral forms. Buehler and Parsons (28) Women aged 18–69 who had not had a Papanicolaou test in the previous 3 years Family medicine clinics in Newfoundland, Canada Letters on the Provincial Cytology Registry's letterhead. Burack et al. (29) Urban minority women aged 39.5 and older who had attended a visit in the previous 18 months HMO Reminder letter mailed to patients was personalized and signed by the medical director of the HMO. Physician reminder notice placed at the front of patient's medical chart. Burack et al. (30) Women aged 18–40 who had attended a visit in the previous year HMO Reminder letter mailed to patients was personalized and signed by the medical director of the HMO. Physician reminder was a notice placed at the front of patient's medical chart. Champion et al. (31) Women aged 51 and older with no mammogram in the previous 15 months HMO patients were primarily white, whereas clinic patients were primarily African American HMO General medicine clinic serving low-income clients Tailored mailing personalized using woman's name, her primary care provider's signature, and tailored information regarding her perceived risk, benefits, and barriers to mammography. Tailored telephone counseling was similar in content to the mailing. Combination of tailored mailing and tailored phone counseling. Champion et al. (32) African American women aged 41–75 who had not had a mammogram within the last 18 months and were at or below 175% of the poverty level General medicine clinic serving low-income clientsParticipants also recruited from multiservice center and an African American convention Tailored interactive computer program tutorial included questions and tailored messages in response to participants’ knowledge of, beliefs about, and barriers to, cancer screening. Targeted videotape, using same video clips as computer program. Costanza et al. (33) Women aged 50–80 who never had a mammogram, had a mammogram but not in the previous 24 months), or had received a mammogram in previous 24 months, but none in the 24 months before that HMOPrimary care providers Barrier-specific telephone counseling identified and addressed specific barriers to mammography. Physician education course including skills practice and role-play and including a $150 incentive to participate. Course follow-up included videos, manual on office systems development, and a free workshop for office staff to improve tracking and follow-up of patient mammography participation. Davis et al. (34) Women aged 50–64 who had not had a mammogram in the previous 18 months HMO Telephone call to patients to schedule an appointment for mammography or address patients’ explanations for refusing to schedule a mammogram. Mammography letters were mailed to those who refused to schedule. Davis et al. (35) Predominantly low-income, African American women aged 40 and older who had not had a mammogram in the previous 12 months Outpatient clinics Personal recommendation to get a mammogram; personal recommendation plus brochure; or one-time group education program, including a soap-opera video. Dickey et al. (36) English- and Spanish-speaking patients aged 19–79 who had visited the provider in the previous 14 months and returned to the provider within 18 months Inner-city family health clinic The patient-held minirecord, or Health Diary, in English or Spanish, described nature and timing of preventive services and had a chart for recording dates and results of preventive services. Nursing staff distributed information sheets to patients and clipped the Health Diary to the medical record. The provider gave the diary to the patient, explained its use, and filled out the record. Dolan et al. (37) Women aged 50 and older who had not had a mammogram in the past 12 months Urban academic general internal medicine practice with a nearby hospital mammography center Opportunity to receive a mammogram at a facility three blocks away immediately after scheduled internal medicine appointment. Free bus transportation to the screening facility. Freedman and Mitchell (38) Predominantly uninsured and Medicaid-covered patients, approximately two-thirds black Inner-city clinic Return completed FOBT cards in person, in addressed envelopes without postage, or in addressed, postage-paid envelopes. Goebel (39) Internal medicine patients, 75% of whom are covered by Medicare or private insurance Medical residents Peer review feedback program, in which physicians reviewed colleagues’ charts and returned them. Original physician completed a form explaining lack of compliance or making a plan for the future. Attending physician reviewed for accuracy and offered feedback. Grady et al. (40) Female patients aged 50 and older, attending primary care practices Primary care physicians Cue enhancement of posters in waiting and treatment rooms and chart stickers for women aged 50 and older that have spaces for recording three mammogram referrals or completions. Cues plus feedback rewards, individualized feedback consisting of a chart illustrating the physician's percent of referrals and patient completions compared with the averages for all physicians in the study, and another chart comparing mammography compliance rates for each physician's patients with the average rate for all physicians in the study. Token rewards consisted of a check based on the percent referred during each audit period. Harris et al. (41) Patients aged 50 and older who had a first-degree relative with a history of colorectal cancer General practices in Australia Pamphlet with information about risk, screening tests, and a tear-off page requesting FOBT. Hart et al. (42) Patients aged 61–70 Large group practice in Britain Invitations to receive free FOBT tests were mailed. Some patients received a leaflet about colorectal cancer screening in addition to the invitation. Herman et al. (43) Women aged 65 and older Public hospital Patient educational materials, including a mammography pamphlet and a sheet outlining the importance of mammography for older women, were given to patients by the nurse at each clinic visit. The nursing staff could complete the radiology request form for screening mammography and attach it to the patient's chart. A health maintenance flow sheet was attached to each patient's chart, and this was updated at each visit. Hillman et al. (44) Female patients aged 50 and older, covered by Medicaid-managed care, 76% black Primary care physicians treating Medicaid-managed care patients Semiannual feedback to primary care providers regarding compliance with screening guidelines: reports documented a site's scores on each screening measure, a total score across all screening types, and plan-wide scores for comparison. Three intervention sites with highest compliance scores received a bonus of 20% of capitation for all female members aged 50 and older, the next three sites received 10% bonuses. Hogg et al. (45) Patients who had visited the office at least once in the previous 24 months Family medicine center in Canada Form letter reminder to families. Customized letter to families, including one page for each family member outlining each preventive procedure for which the patient is eligible, as determined by age, sex, family history, and previous illness. Irwig et al. (46) Women aged 45–70 General practices in Australia Patient reminder letters with and without stated appointment times. Jibaja-Weiss et al. (47) Predominantly minority, low-income women, aged 18–64 Community health centers Some patients were mailed a form letter that contained generic information. Other patients received tailored letter content modified to address specific risk factor data from women's medical charts, including age, race/ethnicity, family history, parity, body mass index, and smoking status. Kern et al. (48) Primary care patients Medical residents Four or more charts we are audited per year by a committee of attending physicians. Residents received a detailed typewritten summary of the findings, comments from the reviewers, an analysis of strengths and weakness in performance, and suggestions for future improvement. King et al. (49) Australian general public aged 45 and older Community intervention with support of general practices in Australia General practitioner letter, with or without description of dietary restrictions, FOBT kit, and colon cancer brochure. King et al. (50) Women aged 50–74 HMO Reminder letter sent 45 days after breast cancer information packet with free mammogram referral was mailed to women. Second reminder letter and preventive office visit letter urging women to have a checkup, or telephone counseling. Counseling content was guided by scripted responses to 26 possible barriers to screening. Kinsinger et al. (51) Patients of family medicine and general internal medicine practices Family and internist physicians, primarily fee-for-service, half group practices, half solo practitioners Practices were encouraged to implement office systems and practice policies, including tools for tracking and prompting screenings and patient education materials. Landis et al. (52) Women aged 50–70 who had been seen twice or more in the previous 24 months and had not had a mammogram in the previous 12 months Family health center Physician prompts were computer-generated cards attached to patient's charts indicating that the patient was eligible for screening mammography and had not had a mammogram in the previous year. The patient letter encouraged all female patients aged 50–70 to have annual screening mammograms, indicated that the records showed that the patient was not up to date with screening, and included a prescription for patients to call and schedule a mammogram directly. Lane and Burg (53) Underserved female patients aged 50 and older Community health centers Mammography provided at health center sites approximately once per month in a mammography van; charges were waived for those without insurance. Lantz et al. (54) Low-income women aged 40–79 without a claim for a mammogram in the previous 18 months (for ages 50 and older) or in the previous 24 months (for ages 40–49), and/or those without a claim for a Papanicolaou test in the previous 36 months Community health center that provides benefits for individuals at or below 200% of the poverty level Reminder letter from primary care physician or medical direct was sent to patients indicating which screening tests were overdue. A follow-up phone call from a health educator was made 7–10 days after the letter was mailed, with the purpose of offering barriers counseling and assistance with appointment scheduling. Lauver and Kane (55) Women aged 51–80 who had not had a mammogram in previous 18 months, but had a previous mammogram Urban hospital mammography clinic serving a high proportion of indigent patients Nurses called patients to discuss knowledge and beliefs regarding mammograms, offer age-appropriate recommendations and rationale for mammography, and discuss patients’ barriers to participating in mammography. Lipkus et al. (56) Women aged 50 and older HMO Tailored print communications addressed personally to the recipient and provided responses to her barriers, reinforced her reasons to get a mammogram, and provided a stage-based message summarizing her readiness to screen. Tailored telephone counseling occurred twice, 2 years apart, by a trained female telephone counselor who followed a scripted computer-based protocol to address the same issues described in the print communications. Mant et al. (57) Patients aged 45–64 who had not been for a health-care visit in 36 months Urban and rural clinics in England and Wales Mailed FOBT kits with or without invitation to attend a health-care visit; invitation for health-care visit at which FOBT would occur; invitation for health-care visit (no mention of FOBT). Mayer et al. (58) Women aged 50 and older who had mammograms in the facility 11 months before the intervention Mammography facility Reminder postcard; reminder postcard plus a voucher for receipt of a gift worth $2; telephone reminder in which patients could schedule their appointment; reminder signed by physician. Miller and Wong (59) Uninsured and privately insured patients Outpatient clinics Patients attending outpatient clinics for acute or routine care were given FOBT packets; some were postage paid and others were not. Mohler (60) Women aged 50–59 who had not had mammograms in the past 24 months but had some contact with the practice in the last 5 years in the form of another visit or a phone call Family practices Personalized physician letters and telephone calls by either a medical assistant or a physician. Phone conversation focused on mammography's effectiveness, physician's desire that the patient have a mammogram, counseling regarding discomfort and costs, and appointment scheduling. Myers et al. (61) Men and women aged 50–74 HMO Mailed FOBT screening kit and a 15-day reminder letter mailed to nonadherers followed by either: a reminder telephone call at 30 days if no tests were returned; a self-held screening booklet included in the screening kit, and a reminder call at 30 days; or an instructional call within 1 week of screening kit mailing in addition to the reminder call at 30 days and self-held screening booklet. Ore et al. (62) HMO patients aged 50–74 Large HMO in Israel Mailed FOBT kit request card; or mailed FOBT kit. Some envelopes contained educational leaflets. Plaskon and Fadden (63) Family practice patients, aged 50–70, who attended the practice for any health-care visit Poor, rural family practice At the end of a patient visit, an FOBT kit, or information packet indicating that patients could request a kit from the office or pharmacy, was distributed. Pritchard et al. (64) Women aged 36–69 who had not had a Papanicolaou test in the previous 24 months Australian general practice in underserved area Reminder on patient chart; patient invitation letter, with instructions on how to make an appointment; or appointment letter in which women were asked to attend a special screening clinic at a specified date and time. Rakowski et al. (65) Women aged 40–74 who had visited a general practitioner or obstetrician/gynecologist during the previous 8 months HMO Mailed materials that were either standard across groups or tailored according to Transtheoretical Model stages. Richards et al. (66) Women registered with a general practitioner and aged 50–64 General practices in areas with low uptake of breast cancer screening, United Kingdom Letter to patients was signed by all partners in the practice, and was sent 1 month before routine invitation for screening. Physician reminder was a card in patient's medical record. Rimer et al. (67) Low-income, predominantly black patients who had visited the center within the past 18 months: women aged 18–49 and women aged 50 and older Community health centers Tailored mailings were sent to patients around the time of their birthdays, integrating patient-level data, such as past screening tests, results, race, and age. Specific recommendations were made regarding cancer screening and overcoming barriers to screening. Tailored telephone counseling consisted of calls to discuss recommended screening, and reasons to be screened, and to identify and overcome a woman's barriers to screening. Printed physician prompts attached to patient charts. Rimer et al. (68) Women aged 40–44 and 50–54 Private insurance plan Mailings were tailored based on stage of mammography readiness, intentions, history, risk factors for breast cancer, perceived risk, barriers to screening, and so on. Tailored telephone counseling followed the print mailings, and addressed barriers to screening. Rosenthal et al. (69) Members of a large California health plan Multispecialty physician organizations Bonuses to medical groups for meeting or exceeding clinical quality targets, set at 75th percentile of performance by physician groups in the previous year. Saywell et al. (70) Women aged 50–85 who had not had a mammogram in the last 15 months HMO In-person counseling or telephone counseling by graduate nurse research assistants regarding susceptibility, benefits, and barriers. Physician reminder letter. Combinations of above strategies. Simon et al. (71) Women aged 39.5 and older who were due for a mammogram and had seen a primary care physician in the previous 18 months Inner-city health department primary care sites with a predominantly African American patient population and low health insurance rates Physician reminder letter signed by the medical director instructed women to visit their PCP to get a free mammogram referral. Letter told women that they could directly arrange a mammogram by calling the office, without a separate visit to the PCP. Skinner et al. (72) Women aged 40–65 visiting family practice within the past 24 months Family practices Tailored mailed letters based on patient perceptions of mammography personal cancer risk, mammography screening status. Somkin et al. (73) Women aged 50–74 with no mammogram in the previous 30 months (mammography intervention); women aged 20–64 with no Papanicolaou test in previous 36 months (Pap intervention) HMO Reminder letter, signed by a physician, described common barriers to screening and provided women with a telephone number to call and schedule a mammogram or Papanicolaou test without referral. Provider reminders were forms placed in medical charts. Taplin et al. (74) Women aged 50–79 due for a mammogram Nonprofit HMO Reminder postcards (subsequent to study invitation that recommended mammography). Reminder phone call from a scheduler. Motivational call designed to address predisposing characteristics of women (and enabling factors in the environment). Valanis et al. (75) Women aged 52–69 who had been plan members for 36 months, but no record of a mammogram in prior 2 years or Papanicolaou test in prior 36 months HMO Tailored letter addressed barriers to screening identified in baseline survey and included a self-referral form to send to health plan scheduling office. Phone call addressed barriers to screening. In-person counseling immediately after primary care visit. Vinker et al. (76) Primary care patients aged 50–75 Primary care clinics in Israel Provider reminder was a note in the patient's medical chart. Patient reminder was either a letter or a phone call. Repeat letters or calls if no FOBT. Provision of FOBT kit, content of letter/call not described. Vogt et al. (77) Women aged 40–70 (mammography intervention) or aged 18–70 (Pap test intervention) who had not received the targeted screening test in the previous 36 months HMO Letter reminder signed by the study investigator indicated that there was no record of mammogram or Pap in the previous 3 years, and provided an appointment scheduling number. Appointments were scheduled as near to the woman's home as possible. Phone call from study interventionist, offering to schedule an appointment, answer questions, address barriers or concerns about screening, and discuss the importance of screening. Combinations of letter/letter, letter/phone, or phone/phone for those noncompliant within 6 weeks. West et al. (78) African American women aged 50–80 who had no mammogram in previous 24 months. Predominantly low income Community health clinic Personalized reminder letter, followed by tailored intervention letter or phone counseling for women who did not respond initially. Reminder letters recommended scheduling an appointment and described how the woman could receive a free mammogram through a public health program. Tailored letters described women's relative risk for developing breast cancer, recommended scheduling, and reminded about the no-cost mammography. Tailored counseling calls by African American health-care workers used a motivational interview approach to elicit barriers and facilitators to getting a mammogram and to review pros and cons of mammography. Yancey et al. (79) Predominantly poor and minority female patients Community health clinics Waiting room video on risk of cervical cancer and pros and cons of cervical cancer screening. Young et al. (80) Low-income black female patients aged 40 and over who had visited their primary care site in the last 24 months; most had no mammogram in past 24 months Community-based primary care clinics One hour cancer education program specific to black women; appointment for free on-site mammography. Reference Patient population Provider population or practice setting Intervention Armour et al. (22) Commercially insured patients aged 50 and older in a managed health-care plan Primary care physicians End-of-year bonus designed to increase colorectal cancer screening; bonus not described. Bankhead et al. (23) Women who had failed to attend a recent appointment for routine third-round breast screening General practices not meeting a target of 70% mammography coverage, United Kingdom Letters from physicians encouraging women to reconsider their decisions not to attend breast screening. Prompt in paper medical records for physicians to discuss breast screening at any routine consultation. Barr et al. (24) Women aged 50–75 who had had a previous mammogram, but not one within the previous 18 months Group model HMO, with most members privately insured Mail reminder indicating a mammogram was due and offering encouragement for the patient to call and schedule an appointment. Telephone call from medical center staff person containing the same information provided in the mailing and giving opportunity to schedule an appointment for clinical breast exam and mammogram referral. Battat et al. (25) VA patients Physicians practicing at VA hospitals Colorectal cancer screening chosen as a performance measure in a quality improvement initiative. Screening directive was issued and implemented (no further details given). Binstock et al. (26) Women aged 25–49 who had not had a Papanicolaou test in the past 3 years HMO with outpatient medical centers Telephone call and letter to patients. Patient chart reminder and memo to primary care provider. Bodiya et al. (27) Women aged 50 and older who had had a mammogram in the previous year and were due for the next annual screening Family practice Reminder letter to women. The letter plus telephone calls by medical assistants, who arranged mammograms and processed referral forms. Buehler and Parsons (28) Women aged 18–69 who had not had a Papanicolaou test in the previous 3 years Family medicine clinics in Newfoundland, Canada Letters on the Provincial Cytology Registry's letterhead. Burack et al. (29) Urban minority women aged 39.5 and older who had attended a visit in the previous 18 months HMO Reminder letter mailed to patients was personalized and signed by the medical director of the HMO. Physician reminder notice placed at the front of patient's medical chart. Burack et al. (30) Women aged 18–40 who had attended a visit in the previous year HMO Reminder letter mailed to patients was personalized and signed by the medical director of the HMO. Physician reminder was a notice placed at the front of patient's medical chart. Champion et al. (31) Women aged 51 and older with no mammogram in the previous 15 months HMO patients were primarily white, whereas clinic patients were primarily African American HMO General medicine clinic serving low-income clients Tailored mailing personalized using woman's name, her primary care provider's signature, and tailored information regarding her perceived risk, benefits, and barriers to mammography. Tailored telephone counseling was similar in content to the mailing. Combination of tailored mailing and tailored phone counseling. Champion et al. (32) African American women aged 41–75 who had not had a mammogram within the last 18 months and were at or below 175% of the poverty level General medicine clinic serving low-income clientsParticipants also recruited from multiservice center and an African American convention Tailored interactive computer program tutorial included questions and tailored messages in response to participants’ knowledge of, beliefs about, and barriers to, cancer screening. Targeted videotape, using same video clips as computer program. Costanza et al. (33) Women aged 50–80 who never had a mammogram, had a mammogram but not in the previous 24 months), or had received a mammogram in previous 24 months, but none in the 24 months before that HMOPrimary care providers Barrier-specific telephone counseling identified and addressed specific barriers to mammography. Physician education course including skills practice and role-play and including a $150 incentive to participate. Course follow-up included videos, manual on office systems development, and a free workshop for office staff to improve tracking and follow-up of patient mammography participation. Davis et al. (34) Women aged 50–64 who had not had a mammogram in the previous 18 months HMO Telephone call to patients to schedule an appointment for mammography or address patients’ explanations for refusing to schedule a mammogram. Mammography letters were mailed to those who refused to schedule. Davis et al. (35) Predominantly low-income, African American women aged 40 and older who had not had a mammogram in the previous 12 months Outpatient clinics Personal recommendation to get a mammogram; personal recommendation plus brochure; or one-time group education program, including a soap-opera video. Dickey et al. (36) English- and Spanish-speaking patients aged 19–79 who had visited the provider in the previous 14 months and returned to the provider within 18 months Inner-city family health clinic The patient-held minirecord, or Health Diary, in English or Spanish, described nature and timing of preventive services and had a chart for recording dates and results of preventive services. Nursing staff distributed information sheets to patients and clipped the Health Diary to the medical record. The provider gave the diary to the patient, explained its use, and filled out the record. Dolan et al. (37) Women aged 50 and older who had not had a mammogram in the past 12 months Urban academic general internal medicine practice with a nearby hospital mammography center Opportunity to receive a mammogram at a facility three blocks away immediately after scheduled internal medicine appointment. Free bus transportation to the screening facility. Freedman and Mitchell (38) Predominantly uninsured and Medicaid-covered patients, approximately two-thirds black Inner-city clinic Return completed FOBT cards in person, in addressed envelopes without postage, or in addressed, postage-paid envelopes. Goebel (39) Internal medicine patients, 75% of whom are covered by Medicare or private insurance Medical residents Peer review feedback program, in which physicians reviewed colleagues’ charts and returned them. Original physician completed a form explaining lack of compliance or making a plan for the future. Attending physician reviewed for accuracy and offered feedback. Grady et al. (40) Female patients aged 50 and older, attending primary care practices Primary care physicians Cue enhancement of posters in waiting and treatment rooms and chart stickers for women aged 50 and older that have spaces for recording three mammogram referrals or completions. Cues plus feedback rewards, individualized feedback consisting of a chart illustrating the physician's percent of referrals and patient completions compared with the averages for all physicians in the study, and another chart comparing mammography compliance rates for each physician's patients with the average rate for all physicians in the study. Token rewards consisted of a check based on the percent referred during each audit period. Harris et al. (41) Patients aged 50 and older who had a first-degree relative with a history of colorectal cancer General practices in Australia Pamphlet with information about risk, screening tests, and a tear-off page requesting FOBT. Hart et al. (42) Patients aged 61–70 Large group practice in Britain Invitations to receive free FOBT tests were mailed. Some patients received a leaflet about colorectal cancer screening in addition to the invitation. Herman et al. (43) Women aged 65 and older Public hospital Patient educational materials, including a mammography pamphlet and a sheet outlining the importance of mammography for older women, were given to patients by the nurse at each clinic visit. The nursing staff could complete the radiology request form for screening mammography and attach it to the patient's chart. A health maintenance flow sheet was attached to each patient's chart, and this was updated at each visit. Hillman et al. (44) Female patients aged 50 and older, covered by Medicaid-managed care, 76% black Primary care physicians treating Medicaid-managed care patients Semiannual feedback to primary care providers regarding compliance with screening guidelines: reports documented a site's scores on each screening measure, a total score across all screening types, and plan-wide scores for comparison. Three intervention sites with highest compliance scores received a bonus of 20% of capitation for all female members aged 50 and older, the next three sites received 10% bonuses. Hogg et al. (45) Patients who had visited the office at least once in the previous 24 months Family medicine center in Canada Form letter reminder to families. Customized letter to families, including one page for each family member outlining each preventive procedure for which the patient is eligible, as determined by age, sex, family history, and previous illness. Irwig et al. (46) Women aged 45–70 General practices in Australia Patient reminder letters with and without stated appointment times. Jibaja-Weiss et al. (47) Predominantly minority, low-income women, aged 18–64 Community health centers Some patients were mailed a form letter that contained generic information. Other patients received tailored letter content modified to address specific risk factor data from women's medical charts, including age, race/ethnicity, family history, parity, body mass index, and smoking status. Kern et al. (48) Primary care patients Medical residents Four or more charts we are audited per year by a committee of attending physicians. Residents received a detailed typewritten summary of the findings, comments from the reviewers, an analysis of strengths and weakness in performance, and suggestions for future improvement. King et al. (49) Australian general public aged 45 and older Community intervention with support of general practices in Australia General practitioner letter, with or without description of dietary restrictions, FOBT kit, and colon cancer brochure. King et al. (50) Women aged 50–74 HMO Reminder letter sent 45 days after breast cancer information packet with free mammogram referral was mailed to women. Second reminder letter and preventive office visit letter urging women to have a checkup, or telephone counseling. Counseling content was guided by scripted responses to 26 possible barriers to screening. Kinsinger et al. (51) Patients of family medicine and general internal medicine practices Family and internist physicians, primarily fee-for-service, half group practices, half solo practitioners Practices were encouraged to implement office systems and practice policies, including tools for tracking and prompting screenings and patient education materials. Landis et al. (52) Women aged 50–70 who had been seen twice or more in the previous 24 months and had not had a mammogram in the previous 12 months Family health center Physician prompts were computer-generated cards attached to patient's charts indicating that the patient was eligible for screening mammography and had not had a mammogram in the previous year. The patient letter encouraged all female patients aged 50–70 to have annual screening mammograms, indicated that the records showed that the patient was not up to date with screening, and included a prescription for patients to call and schedule a mammogram directly. Lane and Burg (53) Underserved female patients aged 50 and older Community health centers Mammography provided at health center sites approximately once per month in a mammography van; charges were waived for those without insurance. Lantz et al. (54) Low-income women aged 40–79 without a claim for a mammogram in the previous 18 months (for ages 50 and older) or in the previous 24 months (for ages 40–49), and/or those without a claim for a Papanicolaou test in the previous 36 months Community health center that provides benefits for individuals at or below 200% of the poverty level Reminder letter from primary care physician or medical direct was sent to patients indicating which screening tests were overdue. A follow-up phone call from a health educator was made 7–10 days after the letter was mailed, with the purpose of offering barriers counseling and assistance with appointment scheduling. Lauver and Kane (55) Women aged 51–80 who had not had a mammogram in previous 18 months, but had a previous mammogram Urban hospital mammography clinic serving a high proportion of indigent patients Nurses called patients to discuss knowledge and beliefs regarding mammograms, offer age-appropriate recommendations and rationale for mammography, and discuss patients’ barriers to participating in mammography. Lipkus et al. (56) Women aged 50 and older HMO Tailored print communications addressed personally to the recipient and provided responses to her barriers, reinforced her reasons to get a mammogram, and provided a stage-based message summarizing her readiness to screen. Tailored telephone counseling occurred twice, 2 years apart, by a trained female telephone counselor who followed a scripted computer-based protocol to address the same issues described in the print communications. Mant et al. (57) Patients aged 45–64 who had not been for a health-care visit in 36 months Urban and rural clinics in England and Wales Mailed FOBT kits with or without invitation to attend a health-care visit; invitation for health-care visit at which FOBT would occur; invitation for health-care visit (no mention of FOBT). Mayer et al. (58) Women aged 50 and older who had mammograms in the facility 11 months before the intervention Mammography facility Reminder postcard; reminder postcard plus a voucher for receipt of a gift worth $2; telephone reminder in which patients could schedule their appointment; reminder signed by physician. Miller and Wong (59) Uninsured and privately insured patients Outpatient clinics Patients attending outpatient clinics for acute or routine care were given FOBT packets; some were postage paid and others were not. Mohler (60) Women aged 50–59 who had not had mammograms in the past 24 months but had some contact with the practice in the last 5 years in the form of another visit or a phone call Family practices Personalized physician letters and telephone calls by either a medical assistant or a physician. Phone conversation focused on mammography's effectiveness, physician's desire that the patient have a mammogram, counseling regarding discomfort and costs, and appointment scheduling. Myers et al. (61) Men and women aged 50–74 HMO Mailed FOBT screening kit and a 15-day reminder letter mailed to nonadherers followed by either: a reminder telephone call at 30 days if no tests were returned; a self-held screening booklet included in the screening kit, and a reminder call at 30 days; or an instructional call within 1 week of screening kit mailing in addition to the reminder call at 30 days and self-held screening booklet. Ore et al. (62) HMO patients aged 50–74 Large HMO in Israel Mailed FOBT kit request card; or mailed FOBT kit. Some envelopes contained educational leaflets. Plaskon and Fadden (63) Family practice patients, aged 50–70, who attended the practice for any health-care visit Poor, rural family practice At the end of a patient visit, an FOBT kit, or information packet indicating that patients could request a kit from the office or pharmacy, was distributed. Pritchard et al. (64) Women aged 36–69 who had not had a Papanicolaou test in the previous 24 months Australian general practice in underserved area Reminder on patient chart; patient invitation letter, with instructions on how to make an appointment; or appointment letter in which women were asked to attend a special screening clinic at a specified date and time. Rakowski et al. (65) Women aged 40–74 who had visited a general practitioner or obstetrician/gynecologist during the previous 8 months HMO Mailed materials that were either standard across groups or tailored according to Transtheoretical Model stages. Richards et al. (66) Women registered with a general practitioner and aged 50–64 General practices in areas with low uptake of breast cancer screening, United Kingdom Letter to patients was signed by all partners in the practice, and was sent 1 month before routine invitation for screening. Physician reminder was a card in patient's medical record. Rimer et al. (67) Low-income, predominantly black patients who had visited the center within the past 18 months: women aged 18–49 and women aged 50 and older Community health centers Tailored mailings were sent to patients around the time of their birthdays, integrating patient-level data, such as past screening tests, results, race, and age. Specific recommendations were made regarding cancer screening and overcoming barriers to screening. Tailored telephone counseling consisted of calls to discuss recommended screening, and reasons to be screened, and to identify and overcome a woman's barriers to screening. Printed physician prompts attached to patient charts. Rimer et al. (68) Women aged 40–44 and 50–54 Private insurance plan Mailings were tailored based on stage of mammography readiness, intentions, history, risk factors for breast cancer, perceived risk, barriers to screening, and so on. Tailored telephone counseling followed the print mailings, and addressed barriers to screening. Rosenthal et al. (69) Members of a large California health plan Multispecialty physician organizations Bonuses to medical groups for meeting or exceeding clinical quality targets, set at 75th percentile of performance by physician groups in the previous year. Saywell et al. (70) Women aged 50–85 who had not had a mammogram in the last 15 months HMO In-person counseling or telephone counseling by graduate nurse research assistants regarding susceptibility, benefits, and barriers. Physician reminder letter. Combinations of above strategies. Simon et al. (71) Women aged 39.5 and older who were due for a mammogram and had seen a primary care physician in the previous 18 months Inner-city health department primary care sites with a predominantly African American patient population and low health insurance rates Physician reminder letter signed by the medical director instructed women to visit their PCP to get a free mammogram referral. Letter told women that they could directly arrange a mammogram by calling the office, without a separate visit to the PCP. Skinner et al. (72) Women aged 40–65 visiting family practice within the past 24 months Family practices Tailored mailed letters based on patient perceptions of mammography personal cancer risk, mammography screening status. Somkin et al. (73) Women aged 50–74 with no mammogram in the previous 30 months (mammography intervention); women aged 20–64 with no Papanicolaou test in previous 36 months (Pap intervention) HMO Reminder letter, signed by a physician, described common barriers to screening and provided women with a telephone number to call and schedule a mammogram or Papanicolaou test without referral. Provider reminders were forms placed in medical charts. Taplin et al. (74) Women aged 50–79 due for a mammogram Nonprofit HMO Reminder postcards (subsequent to study invitation that recommended mammography). Reminder phone call from a scheduler. Motivational call designed to address predisposing characteristics of women (and enabling factors in the environment). Valanis et al. (75) Women aged 52–69 who had been plan members for 36 months, but no record of a mammogram in prior 2 years or Papanicolaou test in prior 36 months HMO Tailored letter addressed barriers to screening identified in baseline survey and included a self-referral form to send to health plan scheduling office. Phone call addressed barriers to screening. In-person counseling immediately after primary care visit. Vinker et al. (76) Primary care patients aged 50–75 Primary care clinics in Israel Provider reminder was a note in the patient's medical chart. Patient reminder was either a letter or a phone call. Repeat letters or calls if no FOBT. Provision of FOBT kit, content of letter/call not described. Vogt et al. (77) Women aged 40–70 (mammography intervention) or aged 18–70 (Pap test intervention) who had not received the targeted screening test in the previous 36 months HMO Letter reminder signed by the study investigator indicated that there was no record of mammogram or Pap in the previous 3 years, and provided an appointment scheduling number. Appointments were scheduled as near to the woman's home as possible. Phone call from study interventionist, offering to schedule an appointment, answer questions, address barriers or concerns about screening, and discuss the importance of screening. Combinations of letter/letter, letter/phone, or phone/phone for those noncompliant within 6 weeks. West et al. (78) African American women aged 50–80 who had no mammogram in previous 24 months. Predominantly low income Community health clinic Personalized reminder letter, followed by tailored intervention letter or phone counseling for women who did not respond initially. Reminder letters recommended scheduling an appointment and described how the woman could receive a free mammogram through a public health program. Tailored letters described women's relative risk for developing breast cancer, recommended scheduling, and reminded about the no-cost mammography. Tailored counseling calls by African American health-care workers used a motivational interview approach to elicit barriers and facilitators to getting a mammogram and to review pros and cons of mammography. Yancey et al. (79) Predominantly poor and minority female patients Community health clinics Waiting room video on risk of cervical cancer and pros and cons of cervical cancer screening. Young et al. (80) Low-income black female patients aged 40 and over who had visited their primary care site in the last 24 months; most had no mammogram in past 24 months Community-based primary care clinics One hour cancer education program specific to black women; appointment for free on-site mammography. * FOBT = fecal occult blood test; HMO = health maintenance organization; VA = Department of Veterans Affairs. Open in new tab Appendix Table 1. Description of organizational intervention studies* Reference Patient population Provider population or practice setting Intervention Armour et al. (22) Commercially insured patients aged 50 and older in a managed health-care plan Primary care physicians End-of-year bonus designed to increase colorectal cancer screening; bonus not described. Bankhead et al. (23) Women who had failed to attend a recent appointment for routine third-round breast screening General practices not meeting a target of 70% mammography coverage, United Kingdom Letters from physicians encouraging women to reconsider their decisions not to attend breast screening. Prompt in paper medical records for physicians to discuss breast screening at any routine consultation. Barr et al. (24) Women aged 50–75 who had had a previous mammogram, but not one within the previous 18 months Group model HMO, with most members privately insured Mail reminder indicating a mammogram was due and offering encouragement for the patient to call and schedule an appointment. Telephone call from medical center staff person containing the same information provided in the mailing and giving opportunity to schedule an appointment for clinical breast exam and mammogram referral. Battat et al. (25) VA patients Physicians practicing at VA hospitals Colorectal cancer screening chosen as a performance measure in a quality improvement initiative. Screening directive was issued and implemented (no further details given). Binstock et al. (26) Women aged 25–49 who had not had a Papanicolaou test in the past 3 years HMO with outpatient medical centers Telephone call and letter to patients. Patient chart reminder and memo to primary care provider. Bodiya et al. (27) Women aged 50 and older who had had a mammogram in the previous year and were due for the next annual screening Family practice Reminder letter to women. The letter plus telephone calls by medical assistants, who arranged mammograms and processed referral forms. Buehler and Parsons (28) Women aged 18–69 who had not had a Papanicolaou test in the previous 3 years Family medicine clinics in Newfoundland, Canada Letters on the Provincial Cytology Registry's letterhead. Burack et al. (29) Urban minority women aged 39.5 and older who had attended a visit in the previous 18 months HMO Reminder letter mailed to patients was personalized and signed by the medical director of the HMO. Physician reminder notice placed at the front of patient's medical chart. Burack et al. (30) Women aged 18–40 who had attended a visit in the previous year HMO Reminder letter mailed to patients was personalized and signed by the medical director of the HMO. Physician reminder was a notice placed at the front of patient's medical chart. Champion et al. (31) Women aged 51 and older with no mammogram in the previous 15 months HMO patients were primarily white, whereas clinic patients were primarily African American HMO General medicine clinic serving low-income clients Tailored mailing personalized using woman's name, her primary care provider's signature, and tailored information regarding her perceived risk, benefits, and barriers to mammography. Tailored telephone counseling was similar in content to the mailing. Combination of tailored mailing and tailored phone counseling. Champion et al. (32) African American women aged 41–75 who had not had a mammogram within the last 18 months and were at or below 175% of the poverty level General medicine clinic serving low-income clientsParticipants also recruited from multiservice center and an African American convention Tailored interactive computer program tutorial included questions and tailored messages in response to participants’ knowledge of, beliefs about, and barriers to, cancer screening. Targeted videotape, using same video clips as computer program. Costanza et al. (33) Women aged 50–80 who never had a mammogram, had a mammogram but not in the previous 24 months), or had received a mammogram in previous 24 months, but none in the 24 months before that HMOPrimary care providers Barrier-specific telephone counseling identified and addressed specific barriers to mammography. Physician education course including skills practice and role-play and including a $150 incentive to participate. Course follow-up included videos, manual on office systems development, and a free workshop for office staff to improve tracking and follow-up of patient mammography participation. Davis et al. (34) Women aged 50–64 who had not had a mammogram in the previous 18 months HMO Telephone call to patients to schedule an appointment for mammography or address patients’ explanations for refusing to schedule a mammogram. Mammography letters were mailed to those who refused to schedule. Davis et al. (35) Predominantly low-income, African American women aged 40 and older who had not had a mammogram in the previous 12 months Outpatient clinics Personal recommendation to get a mammogram; personal recommendation plus brochure; or one-time group education program, including a soap-opera video. Dickey et al. (36) English- and Spanish-speaking patients aged 19–79 who had visited the provider in the previous 14 months and returned to the provider within 18 months Inner-city family health clinic The patient-held minirecord, or Health Diary, in English or Spanish, described nature and timing of preventive services and had a chart for recording dates and results of preventive services. Nursing staff distributed information sheets to patients and clipped the Health Diary to the medical record. The provider gave the diary to the patient, explained its use, and filled out the record. Dolan et al. (37) Women aged 50 and older who had not had a mammogram in the past 12 months Urban academic general internal medicine practice with a nearby hospital mammography center Opportunity to receive a mammogram at a facility three blocks away immediately after scheduled internal medicine appointment. Free bus transportation to the screening facility. Freedman and Mitchell (38) Predominantly uninsured and Medicaid-covered patients, approximately two-thirds black Inner-city clinic Return completed FOBT cards in person, in addressed envelopes without postage, or in addressed, postage-paid envelopes. Goebel (39) Internal medicine patients, 75% of whom are covered by Medicare or private insurance Medical residents Peer review feedback program, in which physicians reviewed colleagues’ charts and returned them. Original physician completed a form explaining lack of compliance or making a plan for the future. Attending physician reviewed for accuracy and offered feedback. Grady et al. (40) Female patients aged 50 and older, attending primary care practices Primary care physicians Cue enhancement of posters in waiting and treatment rooms and chart stickers for women aged 50 and older that have spaces for recording three mammogram referrals or completions. Cues plus feedback rewards, individualized feedback consisting of a chart illustrating the physician's percent of referrals and patient completions compared with the averages for all physicians in the study, and another chart comparing mammography compliance rates for each physician's patients with the average rate for all physicians in the study. Token rewards consisted of a check based on the percent referred during each audit period. Harris et al. (41) Patients aged 50 and older who had a first-degree relative with a history of colorectal cancer General practices in Australia Pamphlet with information about risk, screening tests, and a tear-off page requesting FOBT. Hart et al. (42) Patients aged 61–70 Large group practice in Britain Invitations to receive free FOBT tests were mailed. Some patients received a leaflet about colorectal cancer screening in addition to the invitation. Herman et al. (43) Women aged 65 and older Public hospital Patient educational materials, including a mammography pamphlet and a sheet outlining the importance of mammography for older women, were given to patients by the nurse at each clinic visit. The nursing staff could complete the radiology request form for screening mammography and attach it to the patient's chart. A health maintenance flow sheet was attached to each patient's chart, and this was updated at each visit. Hillman et al. (44) Female patients aged 50 and older, covered by Medicaid-managed care, 76% black Primary care physicians treating Medicaid-managed care patients Semiannual feedback to primary care providers regarding compliance with screening guidelines: reports documented a site's scores on each screening measure, a total score across all screening types, and plan-wide scores for comparison. Three intervention sites with highest compliance scores received a bonus of 20% of capitation for all female members aged 50 and older, the next three sites received 10% bonuses. Hogg et al. (45) Patients who had visited the office at least once in the previous 24 months Family medicine center in Canada Form letter reminder to families. Customized letter to families, including one page for each family member outlining each preventive procedure for which the patient is eligible, as determined by age, sex, family history, and previous illness. Irwig et al. (46) Women aged 45–70 General practices in Australia Patient reminder letters with and without stated appointment times. Jibaja-Weiss et al. (47) Predominantly minority, low-income women, aged 18–64 Community health centers Some patients were mailed a form letter that contained generic information. Other patients received tailored letter content modified to address specific risk factor data from women's medical charts, including age, race/ethnicity, family history, parity, body mass index, and smoking status. Kern et al. (48) Primary care patients Medical residents Four or more charts we are audited per year by a committee of attending physicians. Residents received a detailed typewritten summary of the findings, comments from the reviewers, an analysis of strengths and weakness in performance, and suggestions for future improvement. King et al. (49) Australian general public aged 45 and older Community intervention with support of general practices in Australia General practitioner letter, with or without description of dietary restrictions, FOBT kit, and colon cancer brochure. King et al. (50) Women aged 50–74 HMO Reminder letter sent 45 days after breast cancer information packet with free mammogram referral was mailed to women. Second reminder letter and preventive office visit letter urging women to have a checkup, or telephone counseling. Counseling content was guided by scripted responses to 26 possible barriers to screening. Kinsinger et al. (51) Patients of family medicine and general internal medicine practices Family and internist physicians, primarily fee-for-service, half group practices, half solo practitioners Practices were encouraged to implement office systems and practice policies, including tools for tracking and prompting screenings and patient education materials. Landis et al. (52) Women aged 50–70 who had been seen twice or more in the previous 24 months and had not had a mammogram in the previous 12 months Family health center Physician prompts were computer-generated cards attached to patient's charts indicating that the patient was eligible for screening mammography and had not had a mammogram in the previous year. The patient letter encouraged all female patients aged 50–70 to have annual screening mammograms, indicated that the records showed that the patient was not up to date with screening, and included a prescription for patients to call and schedule a mammogram directly. Lane and Burg (53) Underserved female patients aged 50 and older Community health centers Mammography provided at health center sites approximately once per month in a mammography van; charges were waived for those without insurance. Lantz et al. (54) Low-income women aged 40–79 without a claim for a mammogram in the previous 18 months (for ages 50 and older) or in the previous 24 months (for ages 40–49), and/or those without a claim for a Papanicolaou test in the previous 36 months Community health center that provides benefits for individuals at or below 200% of the poverty level Reminder letter from primary care physician or medical direct was sent to patients indicating which screening tests were overdue. A follow-up phone call from a health educator was made 7–10 days after the letter was mailed, with the purpose of offering barriers counseling and assistance with appointment scheduling. Lauver and Kane (55) Women aged 51–80 who had not had a mammogram in previous 18 months, but had a previous mammogram Urban hospital mammography clinic serving a high proportion of indigent patients Nurses called patients to discuss knowledge and beliefs regarding mammograms, offer age-appropriate recommendations and rationale for mammography, and discuss patients’ barriers to participating in mammography. Lipkus et al. (56) Women aged 50 and older HMO Tailored print communications addressed personally to the recipient and provided responses to her barriers, reinforced her reasons to get a mammogram, and provided a stage-based message summarizing her readiness to screen. Tailored telephone counseling occurred twice, 2 years apart, by a trained female telephone counselor who followed a scripted computer-based protocol to address the same issues described in the print communications. Mant et al. (57) Patients aged 45–64 who had not been for a health-care visit in 36 months Urban and rural clinics in England and Wales Mailed FOBT kits with or without invitation to attend a health-care visit; invitation for health-care visit at which FOBT would occur; invitation for health-care visit (no mention of FOBT). Mayer et al. (58) Women aged 50 and older who had mammograms in the facility 11 months before the intervention Mammography facility Reminder postcard; reminder postcard plus a voucher for receipt of a gift worth $2; telephone reminder in which patients could schedule their appointment; reminder signed by physician. Miller and Wong (59) Uninsured and privately insured patients Outpatient clinics Patients attending outpatient clinics for acute or routine care were given FOBT packets; some were postage paid and others were not. Mohler (60) Women aged 50–59 who had not had mammograms in the past 24 months but had some contact with the practice in the last 5 years in the form of another visit or a phone call Family practices Personalized physician letters and telephone calls by either a medical assistant or a physician. Phone conversation focused on mammography's effectiveness, physician's desire that the patient have a mammogram, counseling regarding discomfort and costs, and appointment scheduling. Myers et al. (61) Men and women aged 50–74 HMO Mailed FOBT screening kit and a 15-day reminder letter mailed to nonadherers followed by either: a reminder telephone call at 30 days if no tests were returned; a self-held screening booklet included in the screening kit, and a reminder call at 30 days; or an instructional call within 1 week of screening kit mailing in addition to the reminder call at 30 days and self-held screening booklet. Ore et al. (62) HMO patients aged 50–74 Large HMO in Israel Mailed FOBT kit request card; or mailed FOBT kit. Some envelopes contained educational leaflets. Plaskon and Fadden (63) Family practice patients, aged 50–70, who attended the practice for any health-care visit Poor, rural family practice At the end of a patient visit, an FOBT kit, or information packet indicating that patients could request a kit from the office or pharmacy, was distributed. Pritchard et al. (64) Women aged 36–69 who had not had a Papanicolaou test in the previous 24 months Australian general practice in underserved area Reminder on patient chart; patient invitation letter, with instructions on how to make an appointment; or appointment letter in which women were asked to attend a special screening clinic at a specified date and time. Rakowski et al. (65) Women aged 40–74 who had visited a general practitioner or obstetrician/gynecologist during the previous 8 months HMO Mailed materials that were either standard across groups or tailored according to Transtheoretical Model stages. Richards et al. (66) Women registered with a general practitioner and aged 50–64 General practices in areas with low uptake of breast cancer screening, United Kingdom Letter to patients was signed by all partners in the practice, and was sent 1 month before routine invitation for screening. Physician reminder was a card in patient's medical record. Rimer et al. (67) Low-income, predominantly black patients who had visited the center within the past 18 months: women aged 18–49 and women aged 50 and older Community health centers Tailored mailings were sent to patients around the time of their birthdays, integrating patient-level data, such as past screening tests, results, race, and age. Specific recommendations were made regarding cancer screening and overcoming barriers to screening. Tailored telephone counseling consisted of calls to discuss recommended screening, and reasons to be screened, and to identify and overcome a woman's barriers to screening. Printed physician prompts attached to patient charts. Rimer et al. (68) Women aged 40–44 and 50–54 Private insurance plan Mailings were tailored based on stage of mammography readiness, intentions, history, risk factors for breast cancer, perceived risk, barriers to screening, and so on. Tailored telephone counseling followed the print mailings, and addressed barriers to screening. Rosenthal et al. (69) Members of a large California health plan Multispecialty physician organizations Bonuses to medical groups for meeting or exceeding clinical quality targets, set at 75th percentile of performance by physician groups in the previous year. Saywell et al. (70) Women aged 50–85 who had not had a mammogram in the last 15 months HMO In-person counseling or telephone counseling by graduate nurse research assistants regarding susceptibility, benefits, and barriers. Physician reminder letter. Combinations of above strategies. Simon et al. (71) Women aged 39.5 and older who were due for a mammogram and had seen a primary care physician in the previous 18 months Inner-city health department primary care sites with a predominantly African American patient population and low health insurance rates Physician reminder letter signed by the medical director instructed women to visit their PCP to get a free mammogram referral. Letter told women that they could directly arrange a mammogram by calling the office, without a separate visit to the PCP. Skinner et al. (72) Women aged 40–65 visiting family practice within the past 24 months Family practices Tailored mailed letters based on patient perceptions of mammography personal cancer risk, mammography screening status. Somkin et al. (73) Women aged 50–74 with no mammogram in the previous 30 months (mammography intervention); women aged 20–64 with no Papanicolaou test in previous 36 months (Pap intervention) HMO Reminder letter, signed by a physician, described common barriers to screening and provided women with a telephone number to call and schedule a mammogram or Papanicolaou test without referral. Provider reminders were forms placed in medical charts. Taplin et al. (74) Women aged 50–79 due for a mammogram Nonprofit HMO Reminder postcards (subsequent to study invitation that recommended mammography). Reminder phone call from a scheduler. Motivational call designed to address predisposing characteristics of women (and enabling factors in the environment). Valanis et al. (75) Women aged 52–69 who had been plan members for 36 months, but no record of a mammogram in prior 2 years or Papanicolaou test in prior 36 months HMO Tailored letter addressed barriers to screening identified in baseline survey and included a self-referral form to send to health plan scheduling office. Phone call addressed barriers to screening. In-person counseling immediately after primary care visit. Vinker et al. (76) Primary care patients aged 50–75 Primary care clinics in Israel Provider reminder was a note in the patient's medical chart. Patient reminder was either a letter or a phone call. Repeat letters or calls if no FOBT. Provision of FOBT kit, content of letter/call not described. Vogt et al. (77) Women aged 40–70 (mammography intervention) or aged 18–70 (Pap test intervention) who had not received the targeted screening test in the previous 36 months HMO Letter reminder signed by the study investigator indicated that there was no record of mammogram or Pap in the previous 3 years, and provided an appointment scheduling number. Appointments were scheduled as near to the woman's home as possible. Phone call from study interventionist, offering to schedule an appointment, answer questions, address barriers or concerns about screening, and discuss the importance of screening. Combinations of letter/letter, letter/phone, or phone/phone for those noncompliant within 6 weeks. West et al. (78) African American women aged 50–80 who had no mammogram in previous 24 months. Predominantly low income Community health clinic Personalized reminder letter, followed by tailored intervention letter or phone counseling for women who did not respond initially. Reminder letters recommended scheduling an appointment and described how the woman could receive a free mammogram through a public health program. Tailored letters described women's relative risk for developing breast cancer, recommended scheduling, and reminded about the no-cost mammography. Tailored counseling calls by African American health-care workers used a motivational interview approach to elicit barriers and facilitators to getting a mammogram and to review pros and cons of mammography. Yancey et al. (79) Predominantly poor and minority female patients Community health clinics Waiting room video on risk of cervical cancer and pros and cons of cervical cancer screening. Young et al. (80) Low-income black female patients aged 40 and over who had visited their primary care site in the last 24 months; most had no mammogram in past 24 months Community-based primary care clinics One hour cancer education program specific to black women; appointment for free on-site mammography. Reference Patient population Provider population or practice setting Intervention Armour et al. (22) Commercially insured patients aged 50 and older in a managed health-care plan Primary care physicians End-of-year bonus designed to increase colorectal cancer screening; bonus not described. Bankhead et al. (23) Women who had failed to attend a recent appointment for routine third-round breast screening General practices not meeting a target of 70% mammography coverage, United Kingdom Letters from physicians encouraging women to reconsider their decisions not to attend breast screening. Prompt in paper medical records for physicians to discuss breast screening at any routine consultation. Barr et al. (24) Women aged 50–75 who had had a previous mammogram, but not one within the previous 18 months Group model HMO, with most members privately insured Mail reminder indicating a mammogram was due and offering encouragement for the patient to call and schedule an appointment. Telephone call from medical center staff person containing the same information provided in the mailing and giving opportunity to schedule an appointment for clinical breast exam and mammogram referral. Battat et al. (25) VA patients Physicians practicing at VA hospitals Colorectal cancer screening chosen as a performance measure in a quality improvement initiative. Screening directive was issued and implemented (no further details given). Binstock et al. (26) Women aged 25–49 who had not had a Papanicolaou test in the past 3 years HMO with outpatient medical centers Telephone call and letter to patients. Patient chart reminder and memo to primary care provider. Bodiya et al. (27) Women aged 50 and older who had had a mammogram in the previous year and were due for the next annual screening Family practice Reminder letter to women. The letter plus telephone calls by medical assistants, who arranged mammograms and processed referral forms. Buehler and Parsons (28) Women aged 18–69 who had not had a Papanicolaou test in the previous 3 years Family medicine clinics in Newfoundland, Canada Letters on the Provincial Cytology Registry's letterhead. Burack et al. (29) Urban minority women aged 39.5 and older who had attended a visit in the previous 18 months HMO Reminder letter mailed to patients was personalized and signed by the medical director of the HMO. Physician reminder notice placed at the front of patient's medical chart. Burack et al. (30) Women aged 18–40 who had attended a visit in the previous year HMO Reminder letter mailed to patients was personalized and signed by the medical director of the HMO. Physician reminder was a notice placed at the front of patient's medical chart. Champion et al. (31) Women aged 51 and older with no mammogram in the previous 15 months HMO patients were primarily white, whereas clinic patients were primarily African American HMO General medicine clinic serving low-income clients Tailored mailing personalized using woman's name, her primary care provider's signature, and tailored information regarding her perceived risk, benefits, and barriers to mammography. Tailored telephone counseling was similar in content to the mailing. Combination of tailored mailing and tailored phone counseling. Champion et al. (32) African American women aged 41–75 who had not had a mammogram within the last 18 months and were at or below 175% of the poverty level General medicine clinic serving low-income clientsParticipants also recruited from multiservice center and an African American convention Tailored interactive computer program tutorial included questions and tailored messages in response to participants’ knowledge of, beliefs about, and barriers to, cancer screening. Targeted videotape, using same video clips as computer program. Costanza et al. (33) Women aged 50–80 who never had a mammogram, had a mammogram but not in the previous 24 months), or had received a mammogram in previous 24 months, but none in the 24 months before that HMOPrimary care providers Barrier-specific telephone counseling identified and addressed specific barriers to mammography. Physician education course including skills practice and role-play and including a $150 incentive to participate. Course follow-up included videos, manual on office systems development, and a free workshop for office staff to improve tracking and follow-up of patient mammography participation. Davis et al. (34) Women aged 50–64 who had not had a mammogram in the previous 18 months HMO Telephone call to patients to schedule an appointment for mammography or address patients’ explanations for refusing to schedule a mammogram. Mammography letters were mailed to those who refused to schedule. Davis et al. (35) Predominantly low-income, African American women aged 40 and older who had not had a mammogram in the previous 12 months Outpatient clinics Personal recommendation to get a mammogram; personal recommendation plus brochure; or one-time group education program, including a soap-opera video. Dickey et al. (36) English- and Spanish-speaking patients aged 19–79 who had visited the provider in the previous 14 months and returned to the provider within 18 months Inner-city family health clinic The patient-held minirecord, or Health Diary, in English or Spanish, described nature and timing of preventive services and had a chart for recording dates and results of preventive services. Nursing staff distributed information sheets to patients and clipped the Health Diary to the medical record. The provider gave the diary to the patient, explained its use, and filled out the record. Dolan et al. (37) Women aged 50 and older who had not had a mammogram in the past 12 months Urban academic general internal medicine practice with a nearby hospital mammography center Opportunity to receive a mammogram at a facility three blocks away immediately after scheduled internal medicine appointment. Free bus transportation to the screening facility. Freedman and Mitchell (38) Predominantly uninsured and Medicaid-covered patients, approximately two-thirds black Inner-city clinic Return completed FOBT cards in person, in addressed envelopes without postage, or in addressed, postage-paid envelopes. Goebel (39) Internal medicine patients, 75% of whom are covered by Medicare or private insurance Medical residents Peer review feedback program, in which physicians reviewed colleagues’ charts and returned them. Original physician completed a form explaining lack of compliance or making a plan for the future. Attending physician reviewed for accuracy and offered feedback. Grady et al. (40) Female patients aged 50 and older, attending primary care practices Primary care physicians Cue enhancement of posters in waiting and treatment rooms and chart stickers for women aged 50 and older that have spaces for recording three mammogram referrals or completions. Cues plus feedback rewards, individualized feedback consisting of a chart illustrating the physician's percent of referrals and patient completions compared with the averages for all physicians in the study, and another chart comparing mammography compliance rates for each physician's patients with the average rate for all physicians in the study. Token rewards consisted of a check based on the percent referred during each audit period. Harris et al. (41) Patients aged 50 and older who had a first-degree relative with a history of colorectal cancer General practices in Australia Pamphlet with information about risk, screening tests, and a tear-off page requesting FOBT. Hart et al. (42) Patients aged 61–70 Large group practice in Britain Invitations to receive free FOBT tests were mailed. Some patients received a leaflet about colorectal cancer screening in addition to the invitation. Herman et al. (43) Women aged 65 and older Public hospital Patient educational materials, including a mammography pamphlet and a sheet outlining the importance of mammography for older women, were given to patients by the nurse at each clinic visit. The nursing staff could complete the radiology request form for screening mammography and attach it to the patient's chart. A health maintenance flow sheet was attached to each patient's chart, and this was updated at each visit. Hillman et al. (44) Female patients aged 50 and older, covered by Medicaid-managed care, 76% black Primary care physicians treating Medicaid-managed care patients Semiannual feedback to primary care providers regarding compliance with screening guidelines: reports documented a site's scores on each screening measure, a total score across all screening types, and plan-wide scores for comparison. Three intervention sites with highest compliance scores received a bonus of 20% of capitation for all female members aged 50 and older, the next three sites received 10% bonuses. Hogg et al. (45) Patients who had visited the office at least once in the previous 24 months Family medicine center in Canada Form letter reminder to families. Customized letter to families, including one page for each family member outlining each preventive procedure for which the patient is eligible, as determined by age, sex, family history, and previous illness. Irwig et al. (46) Women aged 45–70 General practices in Australia Patient reminder letters with and without stated appointment times. Jibaja-Weiss et al. (47) Predominantly minority, low-income women, aged 18–64 Community health centers Some patients were mailed a form letter that contained generic information. Other patients received tailored letter content modified to address specific risk factor data from women's medical charts, including age, race/ethnicity, family history, parity, body mass index, and smoking status. Kern et al. (48) Primary care patients Medical residents Four or more charts we are audited per year by a committee of attending physicians. Residents received a detailed typewritten summary of the findings, comments from the reviewers, an analysis of strengths and weakness in performance, and suggestions for future improvement. King et al. (49) Australian general public aged 45 and older Community intervention with support of general practices in Australia General practitioner letter, with or without description of dietary restrictions, FOBT kit, and colon cancer brochure. King et al. (50) Women aged 50–74 HMO Reminder letter sent 45 days after breast cancer information packet with free mammogram referral was mailed to women. Second reminder letter and preventive office visit letter urging women to have a checkup, or telephone counseling. Counseling content was guided by scripted responses to 26 possible barriers to screening. Kinsinger et al. (51) Patients of family medicine and general internal medicine practices Family and internist physicians, primarily fee-for-service, half group practices, half solo practitioners Practices were encouraged to implement office systems and practice policies, including tools for tracking and prompting screenings and patient education materials. Landis et al. (52) Women aged 50–70 who had been seen twice or more in the previous 24 months and had not had a mammogram in the previous 12 months Family health center Physician prompts were computer-generated cards attached to patient's charts indicating that the patient was eligible for screening mammography and had not had a mammogram in the previous year. The patient letter encouraged all female patients aged 50–70 to have annual screening mammograms, indicated that the records showed that the patient was not up to date with screening, and included a prescription for patients to call and schedule a mammogram directly. Lane and Burg (53) Underserved female patients aged 50 and older Community health centers Mammography provided at health center sites approximately once per month in a mammography van; charges were waived for those without insurance. Lantz et al. (54) Low-income women aged 40–79 without a claim for a mammogram in the previous 18 months (for ages 50 and older) or in the previous 24 months (for ages 40–49), and/or those without a claim for a Papanicolaou test in the previous 36 months Community health center that provides benefits for individuals at or below 200% of the poverty level Reminder letter from primary care physician or medical direct was sent to patients indicating which screening tests were overdue. A follow-up phone call from a health educator was made 7–10 days after the letter was mailed, with the purpose of offering barriers counseling and assistance with appointment scheduling. Lauver and Kane (55) Women aged 51–80 who had not had a mammogram in previous 18 months, but had a previous mammogram Urban hospital mammography clinic serving a high proportion of indigent patients Nurses called patients to discuss knowledge and beliefs regarding mammograms, offer age-appropriate recommendations and rationale for mammography, and discuss patients’ barriers to participating in mammography. Lipkus et al. (56) Women aged 50 and older HMO Tailored print communications addressed personally to the recipient and provided responses to her barriers, reinforced her reasons to get a mammogram, and provided a stage-based message summarizing her readiness to screen. Tailored telephone counseling occurred twice, 2 years apart, by a trained female telephone counselor who followed a scripted computer-based protocol to address the same issues described in the print communications. Mant et al. (57) Patients aged 45–64 who had not been for a health-care visit in 36 months Urban and rural clinics in England and Wales Mailed FOBT kits with or without invitation to attend a health-care visit; invitation for health-care visit at which FOBT would occur; invitation for health-care visit (no mention of FOBT). Mayer et al. (58) Women aged 50 and older who had mammograms in the facility 11 months before the intervention Mammography facility Reminder postcard; reminder postcard plus a voucher for receipt of a gift worth $2; telephone reminder in which patients could schedule their appointment; reminder signed by physician. Miller and Wong (59) Uninsured and privately insured patients Outpatient clinics Patients attending outpatient clinics for acute or routine care were given FOBT packets; some were postage paid and others were not. Mohler (60) Women aged 50–59 who had not had mammograms in the past 24 months but had some contact with the practice in the last 5 years in the form of another visit or a phone call Family practices Personalized physician letters and telephone calls by either a medical assistant or a physician. Phone conversation focused on mammography's effectiveness, physician's desire that the patient have a mammogram, counseling regarding discomfort and costs, and appointment scheduling. Myers et al. (61) Men and women aged 50–74 HMO Mailed FOBT screening kit and a 15-day reminder letter mailed to nonadherers followed by either: a reminder telephone call at 30 days if no tests were returned; a self-held screening booklet included in the screening kit, and a reminder call at 30 days; or an instructional call within 1 week of screening kit mailing in addition to the reminder call at 30 days and self-held screening booklet. Ore et al. (62) HMO patients aged 50–74 Large HMO in Israel Mailed FOBT kit request card; or mailed FOBT kit. Some envelopes contained educational leaflets. Plaskon and Fadden (63) Family practice patients, aged 50–70, who attended the practice for any health-care visit Poor, rural family practice At the end of a patient visit, an FOBT kit, or information packet indicating that patients could request a kit from the office or pharmacy, was distributed. Pritchard et al. (64) Women aged 36–69 who had not had a Papanicolaou test in the previous 24 months Australian general practice in underserved area Reminder on patient chart; patient invitation letter, with instructions on how to make an appointment; or appointment letter in which women were asked to attend a special screening clinic at a specified date and time. Rakowski et al. (65) Women aged 40–74 who had visited a general practitioner or obstetrician/gynecologist during the previous 8 months HMO Mailed materials that were either standard across groups or tailored according to Transtheoretical Model stages. Richards et al. (66) Women registered with a general practitioner and aged 50–64 General practices in areas with low uptake of breast cancer screening, United Kingdom Letter to patients was signed by all partners in the practice, and was sent 1 month before routine invitation for screening. Physician reminder was a card in patient's medical record. Rimer et al. (67) Low-income, predominantly black patients who had visited the center within the past 18 months: women aged 18–49 and women aged 50 and older Community health centers Tailored mailings were sent to patients around the time of their birthdays, integrating patient-level data, such as past screening tests, results, race, and age. Specific recommendations were made regarding cancer screening and overcoming barriers to screening. Tailored telephone counseling consisted of calls to discuss recommended screening, and reasons to be screened, and to identify and overcome a woman's barriers to screening. Printed physician prompts attached to patient charts. Rimer et al. (68) Women aged 40–44 and 50–54 Private insurance plan Mailings were tailored based on stage of mammography readiness, intentions, history, risk factors for breast cancer, perceived risk, barriers to screening, and so on. Tailored telephone counseling followed the print mailings, and addressed barriers to screening. Rosenthal et al. (69) Members of a large California health plan Multispecialty physician organizations Bonuses to medical groups for meeting or exceeding clinical quality targets, set at 75th percentile of performance by physician groups in the previous year. Saywell et al. (70) Women aged 50–85 who had not had a mammogram in the last 15 months HMO In-person counseling or telephone counseling by graduate nurse research assistants regarding susceptibility, benefits, and barriers. Physician reminder letter. Combinations of above strategies. Simon et al. (71) Women aged 39.5 and older who were due for a mammogram and had seen a primary care physician in the previous 18 months Inner-city health department primary care sites with a predominantly African American patient population and low health insurance rates Physician reminder letter signed by the medical director instructed women to visit their PCP to get a free mammogram referral. Letter told women that they could directly arrange a mammogram by calling the office, without a separate visit to the PCP. Skinner et al. (72) Women aged 40–65 visiting family practice within the past 24 months Family practices Tailored mailed letters based on patient perceptions of mammography personal cancer risk, mammography screening status. Somkin et al. (73) Women aged 50–74 with no mammogram in the previous 30 months (mammography intervention); women aged 20–64 with no Papanicolaou test in previous 36 months (Pap intervention) HMO Reminder letter, signed by a physician, described common barriers to screening and provided women with a telephone number to call and schedule a mammogram or Papanicolaou test without referral. Provider reminders were forms placed in medical charts. Taplin et al. (74) Women aged 50–79 due for a mammogram Nonprofit HMO Reminder postcards (subsequent to study invitation that recommended mammography). Reminder phone call from a scheduler. Motivational call designed to address predisposing characteristics of women (and enabling factors in the environment). Valanis et al. (75) Women aged 52–69 who had been plan members for 36 months, but no record of a mammogram in prior 2 years or Papanicolaou test in prior 36 months HMO Tailored letter addressed barriers to screening identified in baseline survey and included a self-referral form to send to health plan scheduling office. Phone call addressed barriers to screening. In-person counseling immediately after primary care visit. Vinker et al. (76) Primary care patients aged 50–75 Primary care clinics in Israel Provider reminder was a note in the patient's medical chart. Patient reminder was either a letter or a phone call. Repeat letters or calls if no FOBT. Provision of FOBT kit, content of letter/call not described. Vogt et al. (77) Women aged 40–70 (mammography intervention) or aged 18–70 (Pap test intervention) who had not received the targeted screening test in the previous 36 months HMO Letter reminder signed by the study investigator indicated that there was no record of mammogram or Pap in the previous 3 years, and provided an appointment scheduling number. Appointments were scheduled as near to the woman's home as possible. Phone call from study interventionist, offering to schedule an appointment, answer questions, address barriers or concerns about screening, and discuss the importance of screening. Combinations of letter/letter, letter/phone, or phone/phone for those noncompliant within 6 weeks. West et al. (78) African American women aged 50–80 who had no mammogram in previous 24 months. Predominantly low income Community health clinic Personalized reminder letter, followed by tailored intervention letter or phone counseling for women who did not respond initially. Reminder letters recommended scheduling an appointment and described how the woman could receive a free mammogram through a public health program. Tailored letters described women's relative risk for developing breast cancer, recommended scheduling, and reminded about the no-cost mammography. Tailored counseling calls by African American health-care workers used a motivational interview approach to elicit barriers and facilitators to getting a mammogram and to review pros and cons of mammography. Yancey et al. (79) Predominantly poor and minority female patients Community health clinics Waiting room video on risk of cervical cancer and pros and cons of cervical cancer screening. Young et al. (80) Low-income black female patients aged 40 and over who had visited their primary care site in the last 24 months; most had no mammogram in past 24 months Community-based primary care clinics One hour cancer education program specific to black women; appointment for free on-site mammography. * FOBT = fecal occult blood test; HMO = health maintenance organization; VA = Department of Veterans Affairs. Open in new tab Appendix Table 2. Description of cross-sectional studies assessing relationship between organizational factors and cancer screening* Reference Setting or respondents Organizational factors measured Carpiano et al. (81) Members of a network of community-based family physicians in northeast Ohio Tenacity (eg, focus on prevention and openness to innovation) Teamwork Tools:  • Patients: patient reminder cards, computer recall, telephone recall  • Providers: computer reminders, checklist, flowchart, risk factor chart sticker, educational  materials in exam room, periodic chart audit  • Office or social marketing: posters, videos, pamphlets  • Personnel or equipment to provide specific preventive services: dietician, colposcopy,  flexible sigmoidoscopy Dickey and Kamerow (82) Primary care providers nationwide Office resources to track and prompt preventive care:  • Flow sheets  • Computers  • Card files  • Chart reminders  • Patient reminders  • Patient minirecords  • Nurse tracking and prompting  • Other tracking or prompting resources Office resources for health education:  • Pamphlets  • Video or slide presentations  • Posters  • Health risk appraisals  • Nurse counseling  • Other counseling resources Engelman et al. (83) Primary care practices in Kansas Office systems:  • Flow sheets  • Computerized reminder systems  • Use of nonphysician personnel to identify patients in need of screening Fenton et al. (84) Patients enrolled in Group Health, Washington State Continuity of care, measured using the usual provider of care index Goldzweig et al. (85) All VA medical centers in the United States Facility features:  • Academic affiliation  • Quality emphasis  • Organizational culture  • Quality improvement commitment Primary care practice features:  • Continuity  • Coordination processes  • Access to primary care  • Quality improvement involvement Greiner et al. (86) Primary care practices in rural Kansas Type of practice (group or multispecialty, solo, other) Frequency of gastroenterologist in area Endoscopy available in practice Haggstrom et al. (87) Community health centers nationwide Local clinic team leadership Senior leadership Financial incentives Access to appointments Role definition and structuring clinical care Guidelines Physician feedback Clinical information technology system Reminders and tracking Patient goal setting Shared decision making Referral to community resources Hudson et al. (88) Suburban primary care practices in New Jersey and Pennsylvania Nonphysician staff for behavioral counseling (unrelated to cancer screening) Health risk assessment protocols or questionnaires Reminder systems Mainous et al. (89) Adult patients at cancer center and community physician's surgical oncology practice Continuity of care, measured with usual provider continuity score Malin et al. (90) Physician organizations in a California network model HMO Medical director beliefs about effectiveness of cancer screening, reasonable expectations for patient screening Screening guidelines Office systems for reminders, tracking, audit and feedback, patient diaries McBride et al. (91) Patients at a closed-panel HMO Difficulty of making appointments Convenience of location Wait time Travel burden Mehrotra et al. (92) Physician groups in California Type of physician group (integrated medical group, individual practice association or hybrid) Patient volume Electronic medical record Physician compensation Quality improvement strategies  • Reminders  • Data collection O'Malley et al. (93) Minority female patients in New York City Continuity of care, measured according to usual site of care and/or usual clinician Parkerton et al. (94) Primary care practices in medical clinics of a group model HMO Continuity of care, measured with usual provider continuity score Practice coordination  • Shared practice across physicians  • Clinic size  • Team tenure Pham et al. (95) Primary care physicians serving Medicare patients nationwide Practice type and size (solo or two person, small group of 3–10, medium or large groups of 11 or more physicians, other) Payer mix Computers or other information technology available for reminders, information seeking Plomondon et al. (96) Commercial managed care organizations reporting data to the National Committee for Quality Assurance Turnover rate Soban and Yano (97) VA medical centers nationwide Primary care versus specialist mix Size (number of patient visits) Space and equipment sufficiency to meet program needs Clinician and support staff sufficiency to meet program's current goals Turner et al. (98) Physicians in community-based fee-for-service practice, prepaid practice, and teaching, hospital-based practice Practice settings Wee et al. (99) Physicians practicing at academically affiliated internal medicine primary care practices in the Boston metropolitan area Physician compensation (salary, salary plus incentives based on productivity, salary plus incentives based on productivity and other factors, such as patient satisfaction, hourly wage) Yano et al. (100) VA medical centers and their primary care practices Practice characteristics  • Primary care versus specialist mix  • Size (number of patient visits)  • Hospital-based vs community-based primary care clinic  • Academic affiliation Centralization  • Implementation of a primary care service line or interdisciplinary division  • Separate budgetary control for primary care program  • Likelihood that cost savings could be recaptured when achieved through increased  primary care efficiency  • Level of primary care authority for practice staffing and human resource management  • Level of primary care director's authority or organizational influence outside of primary care Practice resources  • Sufficiency of nonphysician staffing  • Sufficiency of administrative and clinical space  • Sufficiency of clinical support arrangements Practice complexity  • HMO market penetration  • Academic affiliation Reference Setting or respondents Organizational factors measured Carpiano et al. (81) Members of a network of community-based family physicians in northeast Ohio Tenacity (eg, focus on prevention and openness to innovation) Teamwork Tools:  • Patients: patient reminder cards, computer recall, telephone recall  • Providers: computer reminders, checklist, flowchart, risk factor chart sticker, educational  materials in exam room, periodic chart audit  • Office or social marketing: posters, videos, pamphlets  • Personnel or equipment to provide specific preventive services: dietician, colposcopy,  flexible sigmoidoscopy Dickey and Kamerow (82) Primary care providers nationwide Office resources to track and prompt preventive care:  • Flow sheets  • Computers  • Card files  • Chart reminders  • Patient reminders  • Patient minirecords  • Nurse tracking and prompting  • Other tracking or prompting resources Office resources for health education:  • Pamphlets  • Video or slide presentations  • Posters  • Health risk appraisals  • Nurse counseling  • Other counseling resources Engelman et al. (83) Primary care practices in Kansas Office systems:  • Flow sheets  • Computerized reminder systems  • Use of nonphysician personnel to identify patients in need of screening Fenton et al. (84) Patients enrolled in Group Health, Washington State Continuity of care, measured using the usual provider of care index Goldzweig et al. (85) All VA medical centers in the United States Facility features:  • Academic affiliation  • Quality emphasis  • Organizational culture  • Quality improvement commitment Primary care practice features:  • Continuity  • Coordination processes  • Access to primary care  • Quality improvement involvement Greiner et al. (86) Primary care practices in rural Kansas Type of practice (group or multispecialty, solo, other) Frequency of gastroenterologist in area Endoscopy available in practice Haggstrom et al. (87) Community health centers nationwide Local clinic team leadership Senior leadership Financial incentives Access to appointments Role definition and structuring clinical care Guidelines Physician feedback Clinical information technology system Reminders and tracking Patient goal setting Shared decision making Referral to community resources Hudson et al. (88) Suburban primary care practices in New Jersey and Pennsylvania Nonphysician staff for behavioral counseling (unrelated to cancer screening) Health risk assessment protocols or questionnaires Reminder systems Mainous et al. (89) Adult patients at cancer center and community physician's surgical oncology practice Continuity of care, measured with usual provider continuity score Malin et al. (90) Physician organizations in a California network model HMO Medical director beliefs about effectiveness of cancer screening, reasonable expectations for patient screening Screening guidelines Office systems for reminders, tracking, audit and feedback, patient diaries McBride et al. (91) Patients at a closed-panel HMO Difficulty of making appointments Convenience of location Wait time Travel burden Mehrotra et al. (92) Physician groups in California Type of physician group (integrated medical group, individual practice association or hybrid) Patient volume Electronic medical record Physician compensation Quality improvement strategies  • Reminders  • Data collection O'Malley et al. (93) Minority female patients in New York City Continuity of care, measured according to usual site of care and/or usual clinician Parkerton et al. (94) Primary care practices in medical clinics of a group model HMO Continuity of care, measured with usual provider continuity score Practice coordination  • Shared practice across physicians  • Clinic size  • Team tenure Pham et al. (95) Primary care physicians serving Medicare patients nationwide Practice type and size (solo or two person, small group of 3–10, medium or large groups of 11 or more physicians, other) Payer mix Computers or other information technology available for reminders, information seeking Plomondon et al. (96) Commercial managed care organizations reporting data to the National Committee for Quality Assurance Turnover rate Soban and Yano (97) VA medical centers nationwide Primary care versus specialist mix Size (number of patient visits) Space and equipment sufficiency to meet program needs Clinician and support staff sufficiency to meet program's current goals Turner et al. (98) Physicians in community-based fee-for-service practice, prepaid practice, and teaching, hospital-based practice Practice settings Wee et al. (99) Physicians practicing at academically affiliated internal medicine primary care practices in the Boston metropolitan area Physician compensation (salary, salary plus incentives based on productivity, salary plus incentives based on productivity and other factors, such as patient satisfaction, hourly wage) Yano et al. (100) VA medical centers and their primary care practices Practice characteristics  • Primary care versus specialist mix  • Size (number of patient visits)  • Hospital-based vs community-based primary care clinic  • Academic affiliation Centralization  • Implementation of a primary care service line or interdisciplinary division  • Separate budgetary control for primary care program  • Likelihood that cost savings could be recaptured when achieved through increased  primary care efficiency  • Level of primary care authority for practice staffing and human resource management  • Level of primary care director's authority or organizational influence outside of primary care Practice resources  • Sufficiency of nonphysician staffing  • Sufficiency of administrative and clinical space  • Sufficiency of clinical support arrangements Practice complexity  • HMO market penetration  • Academic affiliation * HMO = health maintenance organizations; VA = Department of Veterans Affairs. Open in new tab Appendix Table 2. Description of cross-sectional studies assessing relationship between organizational factors and cancer screening* Reference Setting or respondents Organizational factors measured Carpiano et al. (81) Members of a network of community-based family physicians in northeast Ohio Tenacity (eg, focus on prevention and openness to innovation) Teamwork Tools:  • Patients: patient reminder cards, computer recall, telephone recall  • Providers: computer reminders, checklist, flowchart, risk factor chart sticker, educational  materials in exam room, periodic chart audit  • Office or social marketing: posters, videos, pamphlets  • Personnel or equipment to provide specific preventive services: dietician, colposcopy,  flexible sigmoidoscopy Dickey and Kamerow (82) Primary care providers nationwide Office resources to track and prompt preventive care:  • Flow sheets  • Computers  • Card files  • Chart reminders  • Patient reminders  • Patient minirecords  • Nurse tracking and prompting  • Other tracking or prompting resources Office resources for health education:  • Pamphlets  • Video or slide presentations  • Posters  • Health risk appraisals  • Nurse counseling  • Other counseling resources Engelman et al. (83) Primary care practices in Kansas Office systems:  • Flow sheets  • Computerized reminder systems  • Use of nonphysician personnel to identify patients in need of screening Fenton et al. (84) Patients enrolled in Group Health, Washington State Continuity of care, measured using the usual provider of care index Goldzweig et al. (85) All VA medical centers in the United States Facility features:  • Academic affiliation  • Quality emphasis  • Organizational culture  • Quality improvement commitment Primary care practice features:  • Continuity  • Coordination processes  • Access to primary care  • Quality improvement involvement Greiner et al. (86) Primary care practices in rural Kansas Type of practice (group or multispecialty, solo, other) Frequency of gastroenterologist in area Endoscopy available in practice Haggstrom et al. (87) Community health centers nationwide Local clinic team leadership Senior leadership Financial incentives Access to appointments Role definition and structuring clinical care Guidelines Physician feedback Clinical information technology system Reminders and tracking Patient goal setting Shared decision making Referral to community resources Hudson et al. (88) Suburban primary care practices in New Jersey and Pennsylvania Nonphysician staff for behavioral counseling (unrelated to cancer screening) Health risk assessment protocols or questionnaires Reminder systems Mainous et al. (89) Adult patients at cancer center and community physician's surgical oncology practice Continuity of care, measured with usual provider continuity score Malin et al. (90) Physician organizations in a California network model HMO Medical director beliefs about effectiveness of cancer screening, reasonable expectations for patient screening Screening guidelines Office systems for reminders, tracking, audit and feedback, patient diaries McBride et al. (91) Patients at a closed-panel HMO Difficulty of making appointments Convenience of location Wait time Travel burden Mehrotra et al. (92) Physician groups in California Type of physician group (integrated medical group, individual practice association or hybrid) Patient volume Electronic medical record Physician compensation Quality improvement strategies  • Reminders  • Data collection O'Malley et al. (93) Minority female patients in New York City Continuity of care, measured according to usual site of care and/or usual clinician Parkerton et al. (94) Primary care practices in medical clinics of a group model HMO Continuity of care, measured with usual provider continuity score Practice coordination  • Shared practice across physicians  • Clinic size  • Team tenure Pham et al. (95) Primary care physicians serving Medicare patients nationwide Practice type and size (solo or two person, small group of 3–10, medium or large groups of 11 or more physicians, other) Payer mix Computers or other information technology available for reminders, information seeking Plomondon et al. (96) Commercial managed care organizations reporting data to the National Committee for Quality Assurance Turnover rate Soban and Yano (97) VA medical centers nationwide Primary care versus specialist mix Size (number of patient visits) Space and equipment sufficiency to meet program needs Clinician and support staff sufficiency to meet program's current goals Turner et al. (98) Physicians in community-based fee-for-service practice, prepaid practice, and teaching, hospital-based practice Practice settings Wee et al. (99) Physicians practicing at academically affiliated internal medicine primary care practices in the Boston metropolitan area Physician compensation (salary, salary plus incentives based on productivity, salary plus incentives based on productivity and other factors, such as patient satisfaction, hourly wage) Yano et al. (100) VA medical centers and their primary care practices Practice characteristics  • Primary care versus specialist mix  • Size (number of patient visits)  • Hospital-based vs community-based primary care clinic  • Academic affiliation Centralization  • Implementation of a primary care service line or interdisciplinary division  • Separate budgetary control for primary care program  • Likelihood that cost savings could be recaptured when achieved through increased  primary care efficiency  • Level of primary care authority for practice staffing and human resource management  • Level of primary care director's authority or organizational influence outside of primary care Practice resources  • Sufficiency of nonphysician staffing  • Sufficiency of administrative and clinical space  • Sufficiency of clinical support arrangements Practice complexity  • HMO market penetration  • Academic affiliation Reference Setting or respondents Organizational factors measured Carpiano et al. (81) Members of a network of community-based family physicians in northeast Ohio Tenacity (eg, focus on prevention and openness to innovation) Teamwork Tools:  • Patients: patient reminder cards, computer recall, telephone recall  • Providers: computer reminders, checklist, flowchart, risk factor chart sticker, educational  materials in exam room, periodic chart audit  • Office or social marketing: posters, videos, pamphlets  • Personnel or equipment to provide specific preventive services: dietician, colposcopy,  flexible sigmoidoscopy Dickey and Kamerow (82) Primary care providers nationwide Office resources to track and prompt preventive care:  • Flow sheets  • Computers  • Card files  • Chart reminders  • Patient reminders  • Patient minirecords  • Nurse tracking and prompting  • Other tracking or prompting resources Office resources for health education:  • Pamphlets  • Video or slide presentations  • Posters  • Health risk appraisals  • Nurse counseling  • Other counseling resources Engelman et al. (83) Primary care practices in Kansas Office systems:  • Flow sheets  • Computerized reminder systems  • Use of nonphysician personnel to identify patients in need of screening Fenton et al. (84) Patients enrolled in Group Health, Washington State Continuity of care, measured using the usual provider of care index Goldzweig et al. (85) All VA medical centers in the United States Facility features:  • Academic affiliation  • Quality emphasis  • Organizational culture  • Quality improvement commitment Primary care practice features:  • Continuity  • Coordination processes  • Access to primary care  • Quality improvement involvement Greiner et al. (86) Primary care practices in rural Kansas Type of practice (group or multispecialty, solo, other) Frequency of gastroenterologist in area Endoscopy available in practice Haggstrom et al. (87) Community health centers nationwide Local clinic team leadership Senior leadership Financial incentives Access to appointments Role definition and structuring clinical care Guidelines Physician feedback Clinical information technology system Reminders and tracking Patient goal setting Shared decision making Referral to community resources Hudson et al. (88) Suburban primary care practices in New Jersey and Pennsylvania Nonphysician staff for behavioral counseling (unrelated to cancer screening) Health risk assessment protocols or questionnaires Reminder systems Mainous et al. (89) Adult patients at cancer center and community physician's surgical oncology practice Continuity of care, measured with usual provider continuity score Malin et al. (90) Physician organizations in a California network model HMO Medical director beliefs about effectiveness of cancer screening, reasonable expectations for patient screening Screening guidelines Office systems for reminders, tracking, audit and feedback, patient diaries McBride et al. (91) Patients at a closed-panel HMO Difficulty of making appointments Convenience of location Wait time Travel burden Mehrotra et al. (92) Physician groups in California Type of physician group (integrated medical group, individual practice association or hybrid) Patient volume Electronic medical record Physician compensation Quality improvement strategies  • Reminders  • Data collection O'Malley et al. (93) Minority female patients in New York City Continuity of care, measured according to usual site of care and/or usual clinician Parkerton et al. (94) Primary care practices in medical clinics of a group model HMO Continuity of care, measured with usual provider continuity score Practice coordination  • Shared practice across physicians  • Clinic size  • Team tenure Pham et al. (95) Primary care physicians serving Medicare patients nationwide Practice type and size (solo or two person, small group of 3–10, medium or large groups of 11 or more physicians, other) Payer mix Computers or other information technology available for reminders, information seeking Plomondon et al. (96) Commercial managed care organizations reporting data to the National Committee for Quality Assurance Turnover rate Soban and Yano (97) VA medical centers nationwide Primary care versus specialist mix Size (number of patient visits) Space and equipment sufficiency to meet program needs Clinician and support staff sufficiency to meet program's current goals Turner et al. (98) Physicians in community-based fee-for-service practice, prepaid practice, and teaching, hospital-based practice Practice settings Wee et al. (99) Physicians practicing at academically affiliated internal medicine primary care practices in the Boston metropolitan area Physician compensation (salary, salary plus incentives based on productivity, salary plus incentives based on productivity and other factors, such as patient satisfaction, hourly wage) Yano et al. (100) VA medical centers and their primary care practices Practice characteristics  • Primary care versus specialist mix  • Size (number of patient visits)  • Hospital-based vs community-based primary care clinic  • Academic affiliation Centralization  • Implementation of a primary care service line or interdisciplinary division  • Separate budgetary control for primary care program  • Likelihood that cost savings could be recaptured when achieved through increased  primary care efficiency  • Level of primary care authority for practice staffing and human resource management  • Level of primary care director's authority or organizational influence outside of primary care Practice resources  • Sufficiency of nonphysician staffing  • Sufficiency of administrative and clinical space  • Sufficiency of clinical support arrangements Practice complexity  • HMO market penetration  • Academic affiliation * HMO = health maintenance organizations; VA = Department of Veterans Affairs. Open in new tab References 1. Humphrey LL , et al. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force , Ann Intern Med. , 2002 , vol. 137 5 pt 1 (pg. 347 - 360 ) Google Scholar Crossref Search ADS PubMed WorldCat 2. Nelson HD , et al. Screening for breast cancer: an update for the U.S. Preventive Services Task Force , Ann Intern Med , 2009 , vol. 151 10 (pg. 727 - 737 ) W237–W242 Google Scholar Crossref Search ADS PubMed WorldCat 3. Pignone M , et al. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force , Ann Intern Med , 2002 , vol. 137 2 (pg. 132 - 141 ) Google Scholar Crossref Search ADS PubMed WorldCat 4. Saslow D , et al. American Cancer Society guideline for the early detection of cervical neoplasia and cancer , CA Cancer J Clin , 2002 , vol. 52 6 (pg. 342 - 362 ) Google Scholar Crossref Search ADS PubMed WorldCat 5. Taplin SH , et al. Chang AE , et al. Screening , Oncology: An Evidence-Based Approach , 2006 New York, NY Springer Science and Business Media, Inc Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 6. Gandhi TK , et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims , Ann Intern Med , 2006 , vol. 145 7 (pg. 488 - 496 ) Google Scholar Crossref Search ADS PubMed WorldCat 7. Weingart SN , et al. Process of care failures in breast cancer diagnosis , J Gen Intern Med , 2009 , vol. 24 6 (pg. 702 - 709 ) Google Scholar Crossref Search ADS PubMed WorldCat 8. Taplin SH , et al. Reason for late-stage breast cancer: absence of screening or detection, or breakdown in follow-up? , J Natl Cancer Inst. , 2004 , vol. 96 20 (pg. 1518 - 1527 ) Google Scholar Crossref Search ADS PubMed WorldCat 9. Leyden WA , et al. Cervical cancer in women with comprehensive health care access: attributable factors in the screening process , J Natl Cancer Inst , 2005 , vol. 97 9 (pg. 675 - 683 ) Google Scholar Crossref Search ADS PubMed WorldCat 10. Ries LA , et al. The annual report to the nation on the status of cancer, 1973-1997, with a special section on colorectal cancer , Cancer , 2000 , vol. 88 10 (pg. 2398 - 2424 ) Google Scholar Crossref Search ADS PubMed WorldCat 11. Klabunde CN , et al. Health plan policies and programs for colorectal cancer screening: a national profile , Am J Manag Care , 2004 , vol. 10 4 (pg. 273 - 279 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 12. Klabunde CN , et al. Colorectal cancer screening by primary care physicians: recommendations and practices, 2006–2007 , Am J Prev Med. , 2009 , vol. 37 1 (pg. 8 - 16 ) Google Scholar Crossref Search ADS PubMed WorldCat 13. Stone EG , et al. Interventions that increase use of adult immunization and cancer screening services: a meta-analysis , Ann Intern Med. , 2002 , vol. 136 9 (pg. 641 - 651 ) Google Scholar Crossref Search ADS PubMed WorldCat 14. Taplin SH , Rodgers AB . Toward improving the quality of cancer care: addressing the interfaces of primary and oncology-related subspecialty care , J Natl Cancer Inst Monogr , 2010 40 (pg. 3 - 10 ) OpenURL Placeholder Text WorldCat 15. Donabedian A . Evaluating the quality of medical care. 1966 , Milbank Q , 2005 , vol. 83 4 (pg. 691 - 729 ) Google Scholar Crossref Search ADS PubMed WorldCat 16. Gustafson DH , Hundt AS . Findings of innovation research applied to quality management principles for health care , Health Care Manage Rev. , 1995 , vol. 20 2 (pg. 16 - 33 ) Google Scholar Crossref Search ADS PubMed WorldCat 17. Green LW , Kreuter MW . , Health Promotion Planning: An Educational and Ecological Approach , 1999 3rd ed Mountain View, CA Mayfield Publishing Co Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 18. Baron RC , et al. Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening a systematic review , Am J Prev Med , 2008 , vol. 35 1 suppl (pg. S34 - S55 ) Google Scholar Crossref Search ADS PubMed WorldCat 19. Baron RC , et al. Client-directed interventions to increase community access to breast, cervical, and colorectal cancer screening a systematic review , Am J Prev Med , 2008 , vol. 35 1 suppl (pg. S56 - S66 ) Google Scholar Crossref Search ADS PubMed WorldCat 20. Sabatino SA , et al. Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers systematic reviews of provider assessment and feedback and provider incentives , Am J Prev Med , 2008 , vol. 35 1 suppl (pg. S67 - S74 ) Google Scholar Crossref Search ADS PubMed WorldCat 21. Glanz K , et al. Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening: Updates of Systematic Reviews Paper presented at: United States Preventive Services Task Force; 2009; Atlanta, GA 22. Armour BS , et al. The influence of year-end bonuses on colorectal cancer screening , Am J Manag Care , 2004 , vol. 10 9 (pg. 617 - 624 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 23. Bankhead C , et al. Improving attendance for breast screening among recent non-attenders: a randomised controlled trial of two interventions in primary care , J Med Screen , 2001 , vol. 8 2 (pg. 99 - 105 ) Google Scholar Crossref Search ADS PubMed WorldCat 24. Barr JK , et al. A randomized intervention to improve ongoing participation in mammography , Am J Manag Care , 2001 , vol. 7 9 (pg. 887 - 894 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 25. Battat AC , et al. Institutional commitment to rectal cancer screening results in earlier-stage cancers on diagnosis , Ann Surg Oncol , 2004 , vol. 11 11 (pg. 970 - 976 ) Google Scholar Crossref Search ADS PubMed WorldCat 26. Binstock MA , et al. Pap smear outreach: a randomized controlled trial in an HMO , Am J Prev Med , 1997 , vol. 13 6 (pg. 425 - 426 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 27. Bodiya A , Vorias D , Dickson HA . Does telephone contact with a physician's office staff improve mammogram screening rates? , Fam Med , 1999 , vol. 31 5 (pg. 324 - 326 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 28. Buehler SK , Parsons WL . Effectiveness of a call/recall system in improving compliance with cervical cancer screening: a randomized controlled trial , CMAJ , 1997 , vol. 157 5 (pg. 521 - 526 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 29. Burack RC , et al. The effect of patient and physician reminders on use of screening mammography in a health maintenance organization. Results of a randomized controlled trial , Cancer , 1996 , vol. 78 8 (pg. 1708 - 1721 ) Google Scholar Crossref Search ADS PubMed WorldCat 30. Burack RC , et al. How reminders given to patients and physicians affected pap smear use in a health maintenance organization: results of a randomized controlled trial , Cancer , 1998 , vol. 82 12 (pg. 2391 - 2400 ) Google Scholar Crossref Search ADS PubMed WorldCat 31. Champion VL , et al. Comparisons of tailored mammography interventions at two months postintervention , Ann Behav Med , 2002 , vol. 24 3 (pg. 211 - 218 ) Google Scholar Crossref Search ADS PubMed WorldCat 32. Champion VL , et al. Comparison of three interventions to increase mammography screening in low income African American women , Cancer Detect Prev , 2006 , vol. 30 6 (pg. 535 - 544 ) Google Scholar Crossref Search ADS PubMed WorldCat 33. Costanza ME , et al. Promoting mammography: results of a randomized trial of telephone counseling and a medical practice intervention , Am J Prev Med , 2000 , vol. 19 1 (pg. 39 - 46 ) Google Scholar Crossref Search ADS PubMed WorldCat 34. Davis NA , et al. Evaluation of a phone intervention to promote mammography in a managed care plan , Am J Health Promot , 1997 , vol. 11 4 (pg. 247 - 249 ) Google Scholar Crossref Search ADS PubMed WorldCat 35. Davis TC , et al. Intervention to increase mammography utilization in a public hospital , J Gen Intern Med , 1998 , vol. 13 4 (pg. 230 - 233 ) Google Scholar Crossref Search ADS PubMed WorldCat 36. Dickey LL , Petitti D . A patient-held minirecord to promote adult preventive care , J Fam Pract , 1992 , vol. 34 4 (pg. 457 - 463 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 37. Dolan NC , et al. Impact of same-day screening mammography availability: results of a controlled clinical trial , Arch Intern Med , 1999 , vol. 159 4 (pg. 393 - 398 ) Google Scholar Crossref Search ADS PubMed WorldCat 38. Freedman JD , Mitchell CK . A simple strategy to improve patient adherence to outpatient fecal occult blood testing , J Gen Intern Med , 1994 , vol. 9 8 (pg. 462 - 464 ) Google Scholar Crossref Search ADS PubMed WorldCat 39. Goebel LJ . A peer review feedback method of promoting compliance with preventive care guidelines in a resident ambulatory care clinic , Jt Comm J Qual Improv , 1997 , vol. 23 4 (pg. 196 - 202 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 40. Grady KE , et al. Enhancing mammography referral in primary care , Prev Med , 1997 , vol. 26 6 (pg. 791 - 800 ) Google Scholar Crossref Search ADS PubMed WorldCat 41. Harris MA , et al. A general practice-based recruitment strategy for colorectal cancer screening , Aust N Z J Public Health , 2000 , vol. 24 4 (pg. 441 - 443 ) Google Scholar Crossref Search ADS PubMed WorldCat 42. Hart AR , et al. The effect on compliance of a health education leaflet in colorectal cancer screening in general practice in central England , J Epidemiol Community Health , 1997 , vol. 51 2 (pg. 187 - 191 ) Google Scholar Crossref Search ADS PubMed WorldCat 43. Herman CJ , Speroff T , Cebul RD . Improving compliance with breast cancer screening in older women. Results of a randomized controlled trial , Arch Intern Med , 1995 , vol. 155 7 (pg. 717 - 722 ) Google Scholar Crossref Search ADS PubMed WorldCat 44. Hillman AL , et al. Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care , Am J Public Health , 1998 , vol. 88 11 (pg. 1699 - 1701 ) Google Scholar Crossref Search ADS PubMed WorldCat 45. Hogg WE , et al. Randomized controlled study of customized preventive medicine reminder letters in a community practice , Can Fam Physician , 1998 , vol. 44 (pg. 81 - 88 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 46. Irwig L , Turnbull D , McMurchie M . A randomised trial of general practitioner-written invitations to encourage attendance at screening mammography , Commun Health Stud. , 1990 , vol. 14 4 (pg. 357 - 364 ) Google Scholar Crossref Search ADS WorldCat 47. Jibaja-Weiss ML , et al. Tailored messages for breast and cervical cancer screening of low-income and minority women using medical records data , Patient Educ Couns , 2003 , vol. 50 2 (pg. 123 - 132 ) Google Scholar Crossref Search ADS PubMed WorldCat 48. Kern DE , et al. Use of an outpatient medical record audit to achieve educational objectives: changes in residents’ performances over six years , J Gen Intern Med , 1990 , vol. 5 3 (pg. 218 - 224 ) Google Scholar Crossref Search ADS PubMed WorldCat 49. King J , et al. Colorectal cancer screening: optimal compliance with postal faecal occult blood test , Aust N Z J Surg , 1992 , vol. 62 9 (pg. 714 - 719 ) Google Scholar Crossref Search ADS PubMed WorldCat 50. King ES , et al. Promoting mammography use through progressive interventions: is it effective? , Am J Public Health , 1994 , vol. 84 1 (pg. 104 - 106 ) Google Scholar Crossref Search ADS PubMed WorldCat 51. Kinsinger LS , et al. Using an office system intervention to increase breast cancer screening , J Gen Intern Med , 1998 , vol. 13 8 (pg. 507 - 514 ) Google Scholar Crossref Search ADS PubMed WorldCat 52. Landis SE , Hulkower SD , Pierson S . Enhancing adherence with mammography through patient letters and physician prompts. A pilot study , N C Med J , 1992 , vol. 53 11 (pg. 575 - 578 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 53. Lane DS , Burg MA . Strategies to increase mammography utilization among community health center visitors. Improving awareness, accessibility, and affordability , Med Care , 1993 , vol. 31 2 (pg. 175 - 181 ) Google Scholar Crossref Search ADS PubMed WorldCat 54. Lantz PM , et al. Breast and cervical cancer screening in a low-income managed care sample: the efficacy of physician letters and phone calls , Am J Public Health , 1995 , vol. 85 6 (pg. 834 - 836 ) Google Scholar Crossref Search ADS PubMed WorldCat 55. Lauver DR , Kane J . A motivational message, external barriers, and mammography utilization , Cancer Detect Prev. , 1999 , vol. 23 3 (pg. 254 - 264 ) Google Scholar Crossref Search ADS PubMed WorldCat 56. Lipkus IM , et al. Can tailored interventions increase mammography use among HMO women? , Am J Prev Med , 2000 , vol. 18 1 (pg. 1 - 10 ) Google Scholar Crossref Search ADS PubMed WorldCat 57. Mant D , et al. Patient compliance with colorectal cancer screening in general practice , Br J Gen Pract , 1992 , vol. 42 354 (pg. 18 - 20 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 58. Mayer JA , et al. Facility-based inreach strategies to promote annual mammograms , Am J Prev Med , 1994 , vol. 10 6 (pg. 353 - 356 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 59. Miller MF , Wong JG . Reducing financial barriers enhances the return rate of stool Hemoccult packets , Am J Med Sci. , 1993 , vol. 306 2 (pg. 98 - 100 ) Google Scholar Crossref Search ADS PubMed WorldCat 60. Mohler PJ . Enhancing compliance with screening mammography recommendations: a clinical trial in a primary care office , Fam Med , 1995 , vol. 27 2 (pg. 117 - 121 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 61. Myers RE , et al. Behavioral interventions to increase adherence in colorectal cancer screening , Med Care , 1991 , vol. 29 10 (pg. 1039 - 1050 ) Google Scholar Crossref Search ADS PubMed WorldCat 62. Ore L , et al. Screening with faecal occult blood test (FOBT) for colorectal cancer: assessment of two methods that attempt to improve compliance , Eur J Cancer Prev , 2001 , vol. 10 3 (pg. 251 - 256 ) Google Scholar Crossref Search ADS PubMed WorldCat 63. Plaskon PP , Fadden MJ . Cancer screening utilization: is there a role for social work in cancer prevention? , Soc Work Health Care , 1995 , vol. 21 4 (pg. 59 - 70 ) Google Scholar Crossref Search ADS PubMed WorldCat 64. Pritchard DA , Straton JA , Hyndman J . Cervical screening in general practice , Aust J Public Health , 1995 , vol. 19 2 (pg. 167 - 172 ) Google Scholar Crossref Search ADS PubMed WorldCat 65. Rakowski W , et al. Increasing mammography among women aged 40–74 by use of a stage-matched, tailored intervention , Prev Med. , 1998 , vol. 27 5 pt 1 (pg. 748 - 756 ) Google Scholar Crossref Search ADS PubMed WorldCat 66. Richards SH , et al. Cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of two primary care interventions aimed at improving attendance for breast screening , J Med Screen , 2001 , vol. 8 2 (pg. 91 - 98 ) Google Scholar Crossref Search ADS PubMed WorldCat 67. Rimer BK , et al. The impact of tailored interventions on a community health center population , Patient Educ Couns , 1999 , vol. 37 2 (pg. 125 - 140 ) Google Scholar Crossref Search ADS PubMed WorldCat 68. Rimer BK , et al. Effects of a mammography decision-making intervention at 12 and 24 months , Am J Prev Med , 2002 , vol. 22 4 (pg. 247 - 257 ) Google Scholar Crossref Search ADS PubMed WorldCat 69. Rosenthal MB , et al. Early experience with pay-for-performance: from concept to practice , JAMA , 2005 , vol. 294 14 (pg. 1788 - 1793 ) Google Scholar Crossref Search ADS PubMed WorldCat 70. Saywell RM Jr , et al. The cost effectiveness of 5 interventions to increase mammography adherence in a managed care population , Am J Manag Care. , 2003 , vol. 9 1 (pg. 33 - 44 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 71. Simon MS , et al. The effect of patient reminders on the use of screening mammography in an urban health department primary care setting , Breast Cancer Res Treat , 2001 , vol. 65 1 (pg. 63 - 70 ) Google Scholar Crossref Search ADS PubMed WorldCat 72. Skinner CS , Strecher VJ , Hospers H . Physicians’ recommendations for mammography: do tailored messages make a difference? , Am J Public Health , 1994 , vol. 84 1 (pg. 43 - 49 ) Google Scholar Crossref Search ADS PubMed WorldCat 73. Somkin CP , et al. The effect of patient and provider reminders on mammography and Papanicolaou smear screening in a large health maintenance organization , Arch Intern Med , 1997 , vol. 157 15 (pg. 1658 - 1664 ) Google Scholar Crossref Search ADS PubMed WorldCat 74. Taplin SH , et al. Testing reminder and motivational telephone calls to increase screening mammography: a randomized study , J Natl Cancer Inst , 2000 , vol. 92 3 (pg. 233 - 242 ) Google Scholar Crossref Search ADS PubMed WorldCat 75. Valanis BG , et al. Screening HMO women overdue for both mammograms and pap tests , Prev Med. , 2002 , vol. 34 1 (pg. 40 - 50 ) Google Scholar Crossref Search ADS PubMed WorldCat 76. Vinker S , et al. The role of family physicians in increasing annual fecal occult blood test screening coverage: a prospective intervention study , Isr Med Assoc J , 2002 , vol. 4 6 (pg. 424 - 425 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 77. Vogt TM , et al. The safety net: a cost-effective approach to improving breast and cervical cancer screening , J Womens Health (Larchmt) , 2003 , vol. 12 8 (pg. 789 - 798 ) Google Scholar Crossref Search ADS PubMed WorldCat 78. West DS , et al. Stepped-care, community clinic interventions to promote mammography use among low-income rural African American women , Health Educ Behav , 2004 , vol. 31 4 suppl 29S–44S OpenURL Placeholder Text WorldCat 79. Yancey AK , et al. Increased cancer screening behavior in women of color by culturally sensitive video exposure , Prev Med , 1995 , vol. 24 2 (pg. 142 - 148 ) Google Scholar Crossref Search ADS PubMed WorldCat 80. Young RF , Waller JB Jr , Smitherman H . A breast cancer education and on-site screening intervention for unscreened African American women , J Cancer Educ , 2002 , vol. 17 4 (pg. 231 - 236 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 81. Carpiano RM , et al. Tools, teamwork, and tenacity: an examination of family practice office system influences on preventive service delivery , Prev Med , 2003 , vol. 36 2 (pg. 131 - 140 ) Google Scholar Crossref Search ADS PubMed WorldCat 82. Dickey LL , Kamerow DB . Primary care physicians’ use of office resources in the provision of preventive care , Arch Fam Med , 1996 , vol. 5 7 (pg. 399 - 404 ) Google Scholar Crossref Search ADS PubMed WorldCat 83. Engelman KK , et al. Office systems and their influence on mammography use in rural and urban primary care , J Rural Health , 2004 , vol. 20 1 (pg. 36 - 42 ) Google Scholar Crossref Search ADS PubMed WorldCat 84. Fenton JJ , et al. Continuity of care and cancer screening among health plan enrollees , Med Care , 2008 , vol. 46 1 (pg. 58 - 62 ) Google Scholar Crossref Search ADS PubMed WorldCat 85. Goldzweig CL , et al. Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates , Am J Manag Care , 2004 , vol. 10 4 (pg. 265 - 272 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 86. Greiner KA , et al. Barriers to colorectal cancer screening in rural primary care , Prev Med , 2004 , vol. 38 3 (pg. 269 - 275 ) Google Scholar Crossref Search ADS PubMed WorldCat 87. Haggstrom DA , et al. , Cancer Collaborative Project Survey. , 2006 88. Hudson SV , et al. The effects of teamwork and system support on colorectal cancer screening in primary care practices , Cancer Detect Prev , 2007 , vol. 31 5 (pg. 417 - 423 ) Google Scholar Crossref Search ADS PubMed WorldCat 89. Mainous AG III , et al. The relationship between continuity of care and trust with stage of cancer at diagnosis , Fam Med , 2004 , vol. 36 1 (pg. 35 - 39 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 90. Malin JL , et al. Organizational systems used by California capitated medical groups and independent practice associations to increase cancer screening , Cancer , 2000 , vol. 88 12 (pg. 2824 - 2831 ) Google Scholar Crossref Search ADS PubMed WorldCat 91. McBride CM , et al. Exploring environmental barriers to participation in mammography screening in an HMO , Cancer Epidemiol Biomarkers Prev , 1993 , vol. 2 6 (pg. 599 - 605 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 92. Mehrotra A , Epstein AM , Rosenthal MB . Do integrated medical groups provide higher-quality medical care than individual practice associations? , Ann Intern Med , 2006 , vol. 145 11 (pg. 826 - 833 ) Google Scholar Crossref Search ADS PubMed WorldCat 93. O'Malley AS , et al. Continuity of care and the use of breast and cervical cancer screening services in a multiethnic community , Arch Intern Med , 1997 , vol. 157 13 (pg. 1462 - 1470 ) Google Scholar Crossref Search ADS PubMed WorldCat 94. Parkerton PH , Smith DG , Straley HL . Primary care practice coordination versus physician continuity , Fam Med. , 2004 , vol. 36 1 (pg. 15 - 21 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 95. Pham HH , et al. Delivery of preventive services to older adults by primary care physicians , JAMA , 2005 , vol. 294 4 (pg. 473 - 481 ) Google Scholar Crossref Search ADS PubMed WorldCat 96. Plomondon ME , et al. Primary care provider turnover and quality in managed care organizations , Am J Manag Care , 2007 , vol. 13 8 (pg. 465 - 472 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 97. Soban LM , Yano EM . The impact of primary care resources on prevention practices , J Ambul Care Manage , 2005 , vol. 28 3 (pg. 241 - 253 ) Google Scholar Crossref Search ADS PubMed WorldCat 98. Turner BJ , et al. Breast cancer screening: effect of physician specialty, practice setting, year of medical school graduation, and sex , Am J Prev Med , 1992 , vol. 8 2 (pg. 78 - 85 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 99. Wee CC , et al. Influence of financial productivity incentives on the use of preventive care , Am J Med , 2001 , vol. 110 3 (pg. 181 - 187 ) Google Scholar Crossref Search ADS PubMed WorldCat 100. Yano EM , et al. Primary care practice organization influences colorectal cancer screening performance , Health Serv Res. , 2007 , vol. 42 3 pt 1 (pg. 1130 - 1149 ) Google Scholar Crossref Search ADS PubMed WorldCat 101. Meissner HI , et al. Which women aren't getting mammograms and why? (United States) , Cancer Causes Control , 2007 , vol. 18 1 (pg. 61 - 70 ) Google Scholar Crossref Search ADS PubMed WorldCat 102. Rosenthal MB , Frank RG . What is the empirical basis for paying for quality in health care? , Med Care Res Rev. , 2006 , vol. 63 2 (pg. 135 - 157 ) Google Scholar Crossref Search ADS PubMed WorldCat 103. Birkmeyer JD , et al. Hospital volume and surgical mortality in the United States , N Engl J Med , 2002 , vol. 346 15 (pg. 1128 - 1137 ) Google Scholar Crossref Search ADS PubMed WorldCat 104. Halm EA , Lee C , Chassin MR . Is volume related to outcome in health care? A systematic review and methodologic critique of the literature , Ann Intern Med , 2002 , vol. 137 6 (pg. 511 - 520 ) Google Scholar Crossref Search ADS PubMed WorldCat 105. Zyzanski SJ , et al. Trade-offs in high-volume primary care practice , J Fam Pract , 1998 , vol. 46 5 (pg. 397 - 402 ) Google Scholar PubMed OpenURL Placeholder Text WorldCat 106. Klabunde CN , et al. Improving colorectal cancer screening in primary care practice: innovative strategies and future directions , J Gen Intern Med , 2007 , vol. 22 8 (pg. 1195 - 1205 ) Google Scholar Crossref Search ADS PubMed WorldCat 107. Haggerty JL , et al. Continuity of care: a multidisciplinary review , BMJ. , 2003 , vol. 327 7425 (pg. 1219 - 1221 ) Google Scholar Crossref Search ADS PubMed WorldCat 108. Guthrie B , et al. Continuity of care matters , BMJ , 2008 , vol. 337 a867 OpenURL Placeholder Text WorldCat 109. Damschroder LJ , et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science , Implement Sci. , 2009 , vol. 4 pg. 50 Google Scholar Crossref Search ADS PubMed WorldCat 110. Goodwin MA , et al. A clinical trial of tailored office systems for preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP) , Am J Prev Med , 2001 , vol. 21 1 (pg. 20 - 28 ) Google Scholar Crossref Search ADS PubMed WorldCat 111. Cohen D , et al. A practice change model for quality improvement in primary care practice , J Healthc Manag , 2004 , vol. 49 3 (pg. 155 - 168 ) discussion 169–170 Google Scholar PubMed OpenURL Placeholder Text WorldCat 112. Dietrich AJ , et al. Cancer early-detection services in community health centers for the underserved. A randomized controlled trial , Arch Fam Med , 1998 , vol. 7 4 (pg. 320 - 327 ) discussion 328 Google Scholar Crossref Search ADS PubMed WorldCat 113. Yano EM . The role of organizational research in implementing evidence-based practice: QUERI Series , Implement Sci. , 2008 , vol. 3 pg. 29 Google Scholar Crossref Search ADS PubMed WorldCat 114. Casalino L , et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases , JAMA , 2003 , vol. 289 4 (pg. 434 - 441 ) Google Scholar Crossref Search ADS PubMed WorldCat 115. Shortell SM , et al. The role of perceived team effectiveness in improving chronic illness care , Med Care , 2004 , vol. 42 11 (pg. 1040 - 1048 ) Google Scholar Crossref Search ADS PubMed WorldCat 116. Crabtree BF , et al. Delivery of clinical preventive services in family medicine offices , Ann Fam Med , 2005 , vol. 3 5 (pg. 430 - 435 ) Google Scholar Crossref Search ADS PubMed WorldCat 117. Keroack MA , et al. Organizational factors associated with high performance in quality and safety in academic medical centers , Acad Med , 2007 , vol. 82 12 (pg. 1178 - 1186 ) Google Scholar Crossref Search ADS PubMed WorldCat 118. Glasgow RE , Orleans CT , Wagner EH . Does the chronic care model serve also as a template for improving prevention? , Milbank Q , 2001 , vol. 79 4 (pg. 579 - 612 ) iv–v Google Scholar Crossref Search ADS PubMed WorldCat 119. Yabroff KR . Interventions to improve cancer screening: commentary from a health services research perspective , Am J Prev Med , 2008 , vol. 35 1 suppl (pg. S6 - S9 ) Google Scholar Crossref Search ADS PubMed WorldCat 120. Baron RC , et al. Methods for conducting systematic reviews of evidence on effectiveness and economic efficiency of interventions to increase screening for breast, cervical, and colorectal cancers , Am J Prev Med , 2008 , vol. 35 1 suppl (pg. S26 - S33 ) Google Scholar Crossref Search ADS PubMed WorldCat 121. Bonomi AE , et al. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement , Health Serv Res. , 2002 , vol. 37 3 (pg. 791 - 820 ) Google Scholar Crossref Search ADS PubMed WorldCat 122. Ohman-Strickland PA , et al. Measuring organizational attributes of primary care practices: development of a new instrument , Health Serv Res. , 2007 , vol. 42 3 pt 1 (pg. 1257 - 1273 ) Google Scholar Crossref Search ADS PubMed WorldCat 123. Mohr JJ , Batalden PB . Improving safety on the front lines: the role of clinical microsystems , Qual Saf Health Care , 2002 , vol. 11 1 (pg. 45 - 50 ) Google Scholar Crossref Search ADS PubMed WorldCat 124. Solberg LI , et al. Delivering clinical preventive services is a systems problem , Ann Behav Med , 1997 , vol. 19 3 (pg. 271 - 278 ) Google Scholar Crossref Search ADS PubMed WorldCat © The Author 2010. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JNCI Monographs Oxford University Press

Organizational Factors and the Cancer Screening Process

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