Tools, teamwork, and tenacity: an office system for cancer prevention

Despite national priorities in cancer control, the number of people with established ongoing medical care who do not receive indicated preventive services is substantial. Proven strategies to optimize preventive care in community practice are limited.

In the Cancer Prevention in Community Practice Project (CPCP), 50 primary care providers were randomly assigned to receive an "office system" intervention. The intervention led to reorganization of office operations based on four functional core components: identifying patients' needs for services; monitoring their status over time; providing positive reinforcement to patients; and establishing an internal feedback component consisting of a brief audit to assess how the system is operating. Implementation of the CPCP system in each practice was accomplished using trained facilitators, and involved incorporating one or more tools developed to meet the functional components of the practice.

One hundred percent of the practices were successful in implementing some changes in their office operations that met CPCP office system functional criteria. All study practices implemented customized flow sheets, while use of other office system tools were incorporated at between 32% to 75% of study sites. Identifying patients in need of preventive services was performed most often by the clinical staff (39%), whereas monitoring patients' receipt of preventive services over time and reinforcing positive patient behavior were performed most often by physicians (63% and 46%, respectively). Changes made in practices were maintained for at least 12 months.

Primary care practices in community settings can implement significant and lasting changes in their practice environment that will improve their performance of preventive activities. The functional components of the CPCP office system design proposed and tested here are applicable to a wide variety of practice settings.