Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice
BackgroundDespite substantial resources devoted to cancer screening nationally, the availability of clinical practice based systems to support screening guidelines is not known.ObjectiveTo characterize the prevalence and correlates of practice based systems to support breast and cervical cancer screening, with a focus on the patient centered medical home (PCMH).DesignWeb and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice based systems and technology to support guideline adherent screening.ParticipantsPrimary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population based Research Optimizing Screening through Personalized Regimens) consortium research centers.Main MeasuresThe prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow up.Key ResultsThere were 385 participants (57.6 of eligible) Forty seven percent (47.0 of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 or cervical cancer (46.2 screening. A minority received comparative performance reports for breast (26.2 or cervical (19.7 cancer screening, automated reports of patients overdue for breast (18.7 or cervical (16.4 cancer screening, or follow up of abnormal breast (18.1 or cervical (17.6 cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guideline adherent breast (OR 3.23, 95 CI 1.58 6.61) or cervical (OR 2.56, 95 CI 1.32 4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 CI 1.15 41.7) or cervical (OR. 2.56, 95 CI 1.26 5.26) cancer screening.ConclusionsProviders lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline adherent cancer screening in primary care settings.
Journal of General Internal Medicine