1. Improving Cancer Screening Among Low Income Women: a randomized controlled trial NCI R01 CA87776 Allen J. Dietrich, MD NAPCRG 2005 Annual Meeting October 15-18, 2005

2. Other Authors Clinical Directors Network (CDN): Jonathan N. Tobin, PhD Andrea Cassells, MPH Richard G. Younge, MD MPH Norris Cotton Cancer Center/Dartmouth Christina Robinson, MS Mary Ann Greene, MS Elaine Livingston Cheryl Lofgren

3. Background Disparities persist in cancer screening for low income and certain ethnic and racial groups. Evidence base for interventions to address these disparities is weak.

4. Background An office system intervention increased cancer screening and was sustainable in 98 rural practices (Dietrich AJ, et al British Medical Journal,1992 304:687-691. NCI R01 CA46075) A similar office system failed to show impact in 60 urban practices (check cite from 1998 archives of fm-me first author-give nci grant #)

5. Study Question Can centralized telephone support increase cancer screening for women 50-69 years of age seen in New York City Community Health Centers?

6. Setting: Clinical Directors Network Practice-Based Research Network (PBRN) with 11 sites involved A clinician peer training organization Mission to translate research into practice to eliminate health disparities www.CDNetwork.org

7. Target Women Age 50-69 years Overdue for Pap, mammogram or CRC Waiting room recruitment

8. Project Framework PRECEDE-PROCEED MODEL LW Green, 2005 Ask me for citation

9. Intervention Prevention Care Management Waiting room recruitment of women. Enroll if overdue for breast, pap or CRC. Phone follow- up. Assess barriers, priorities, motivation. Series of calls to predispose, enable, reinforce.

10. Barriers to CRC Screening No information Misinformation No clinician recommendation Ogedegbe G, et al. J Natl Med Assoc Feb 2005 97(2): 162-171

11. Characteristics of Participating C/MHCs (n=11) CharacteristicMeanRange Total medical visits (2002)8040128215-165952 English Primary Language49.510-85% Spanish Primary Language39.212-90% Other Primary Language11.30-40% # of Primary Care Clinicians10.55-29 Family Practice2.70-8 General Internal Medicine3.70-9 Nurse Practitioner/Physician’s Assistants 4.10-17 Clinician Years at Practice5.51.3-12.9

12. Characteristics of Subjects Patient CharacteristicPCM Intervention (n=696) Usual Care (n=694) Mean Age (S.D.) at consent58.1 (5.3)58.1 (5.2) Primary language Spanish44664.1%42761.5% Insurance Medicaid55379.5%54378.2% None365.2%365.2% Years at C/MHC ≥3 Years47167.7%47969.0%

13. Proportion Up-to-date by Test (n=1406)

15. Insert Table 4 from Annals