Evidence map›Paper›PMID 27613786›Full record

ArticleJournal of the American Board of Family Medicine : JABFM

A Practice Facilitation and Academic Detailing Intervention Can Improve Cancer Screening Rates in Primary Care Safety Net Clinics.

Emily M Mader, Chester H Fox, John W Epling, Gary J Noronha, Carlos M Swanger, Angela M Wisniewski, Karen Vitale, Amanda L Norton, Christopher P Morley

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Board of Family Medicine : JABFM. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  5. Intervention to Improve Psychosocial Care for People with Type 2 Diabetes.Journal of the American Board of Family Medicine : JABFM · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Emily M MaderFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Chester H FoxFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
John W EplingFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Gary J NoronhaFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Carlos M SwangerFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Angela M WisniewskiFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Karen VitaleFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Amanda L NortonFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM).
Christopher P MorleyFrom the Department of Family Medicine, State University of New York Upstate Medical University, Syracuse (EMM, JWE, ALN, CPM); the Department of Family Medicine, State University of New York at Buffalo (CHF, AMW); the Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse (JWE, CPM); the Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY (GJN, CMS); the Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester (KV); and the Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse (CPM). morleycp@upstate.edu.

Funding

NCCDPHP CDC HHS U58 DP002029NCCDPHP CDC HHS U58 DP003879
6 · The paper itself

Abstract

backgroundDespite the current evidence of preventive screening effectiveness, rates of breast, cervical, and colorectal cancer in the United States fall below national targets. We evaluated the efficacy and feasibility of combining practice facilitation and academic detailing quality improvement (QI) strategies to help primary care practices increase breast, cervical, and colorectal cancer screening among patients.

methodsPractices received a 1-hour academic detailing session addressing current cancer screening guidelines and best practices, followed by 6 months of practice facilitation to implement evidence-based interventions aimed at increasing patient screening. One-way repeated measures analysis of variance compared screening rates before and after the intervention, provider surveys, and TRANSLATE model scores. Qualitative data were gathered via participant focus groups and interviews.

resultsTwenty-three practices enrolled in the project: 4 federally qualified health centers, 10 practices affiliated with larger health systems, 4 physician-owned practices, 4 university hospital clinics, and 1 nonprofit clinic. Average screening rates for breast cancer increased by 13% (P = .001), and rates for colorectal cancer increased by 5.6% (P = .001). Practices implemented a mix of electronic health record data cleaning workflows, provider audits and feedback, reminder systems streamlining, and patient education and outreach interventions. Practice facilitators assisted practices in tailoring interventions to practice-specific priorities and constraints and in connecting with community resources. Practices with resource constraints benefited from the engagement of all levels of staff in the quality improvement processes and from team-based adaptations to office workflows and policies. Many practices aligned quality improvement interventions in this project with patient-centered medical home and other regulatory reporting targets.

conclusionsCombining practice facilitation and academic detailing is 1 method through which primary care practices can achieve systems-level changes to better manage patient population health.

Indexed as

Practice Patterns, Physicians'Quality ImprovementBreast NeoplasmsColorectal NeoplasmsEarly Detection of CancerElectronic Health RecordsEvidence-Based MedicineFeasibility StudiesFemaleFocus GroupsHealth Care SurveysHumansMiddle AgedPatient-Centered CarePrimary Health CareSafety-net ProvidersAnalysis of VarianceBreast CancerCancer Prevention & ControlCervical CancerColorectal CancerEarly Detection of CancerFocus GroupsImprovementPrimary Health CareQualityReminder SystemsSurveys & QuestionnairesWorkflow

Identifiers

PMID27613786
PMCPMC13054612

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.