Search PubMed⌕ Search

Biomedical subjects

A Kaluzny

Publications and source records attributed to A Kaluzny.

12 recordsLinked to original sources
PubMed1998

Using an office system intervention to increase breast cancer screening.

OBJECTIVE: To evaluate an innovative approach to continuing medical education, an outreach intervention designed to improve performance rates of breast cancer screening through implementation of office systems in community primary care practices. DESIGN: Randomized, controlled trial with primary care practices assigned to either the intervention group or control group, with the practice as the unit of analysis. SETTING: Twenty mostly rural counties in North Carolina. PARTICIPANTS: Physicians and staff of 62 randomly selected family medicine and general internal medicine practices, primarily fee-for-service, half group practices and half solo practitioners. INTERVENTION: Physician investigators and facilitators met with practice physicians and staff over a period of 12 to 18 months to provide feedback on breast cancer screening performance, and to assist these primary care practices in developing office systems tailored to increase breast cancer screening. MEASUREMENTS AND MAIN RESULTS: Physician questionnaires were obtained at baseline and follow-up to assess the presence of five indicators of an office system. Three of the five indicators of office systems increased significantly more in intervention practices than in control practices, but the mean number of indicators in intervention practices at followup was only 2.8 out of 5. Cross-sectional reviews of randomly chosen medical records of eligible women patients aged 50 years and over were done at baseline (n = 2,887) and follow-up (n = 2,874) to determine whether clinical breast examinations and mammography, were performed. Results for mammography were recorded in two ways, mention of the test in the visit note and actual report of the test in the medical record. These reviews showed an increase from 39% to 51% in mention of mammography in intervention practices, compared with an increase from 41% to 44% in control practices (p = .01). There was no significant difference, however, between the two groups in change in mammograms reported (intervention group increased from 28% to 32.7%; control group increased from 30.6% to 34.0%, p = .56). There was a nonsignificant trend (p = .06) toward a greater increase in performance of clinical breast examination in intervention versus control practices. CONCLUSIONS: A moderately intensive outreach intervention to increase rates of breast cancer screening through the development of office systems was modestly successful in increasing indicators of office systems and in documenting mention of mammography, but had little impact on actual performance of breast cancer screening. At follow-up, few practices had a complete office system for breast cancer screening. Outreach approaches to assist primary care practices implement office systems are promising but need further development.

Aged↗
PubMed1994

Effect of a National Cancer Institute Clinical Alert on breast cancer practice patterns.

PURPOSE: This study evaluates the effect of the 1988 National Cancer Institute Clinical Alert regarding treatment of early-stage breast cancer on the patterns of treatment provided to patients. PATIENTS AND METHODS: Data analyzed were collected from the hospital and outpatient records of 12,534 female patients with a primary diagnosis of breast cancer (stages I and II) initially diagnosed during the years 1983 through 1989. RESULTS: Analyses revealed that the proportions of patients with a negative lymph node status diagnosed after the May 1988 Clinical Alert who received adjuvant treatment (tamoxifen and/or multidrug chemotherapy) were significantly greater than predicted from treatment trends established before the Alert's release. Proportions of patients with positive lymph node status receiving adjuvant therapy subsequent to the Alert's release, in contrast, did not fall outside the projected confidence intervals for that group. Additional analyses showed a significant effect of the Clinical Alert among several subgroups of node-negative patients. CONCLUSION: Findings suggest that the Clinical Alert mechanism, followed by publication in the peer-reviewed scientific literature, is an effective way to communicate important research findings to practitioners in the community. However, the Alert mechanism is controversial and should be used judiciously to ensure its credibility.

Adult↗
PubMed1993

Assuring access to state-of-the-art care for U.S. minority populations: the first 2 years of the Minority-Based Community Clinical Oncology Program.

BACKGROUND: The Minority-Based Community Clinical Oncology Program (MBCCOP) was initiated in September 1990 to expand the National Cancer Institute's (NCI's) clinical trials network to minority populations. Institutions, organizations, and/or physician groups that had more than 50% of new cancer patients from minority groups were eligible to participate. There has been no previous evaluation of the MBCCOP. PURPOSE: This study was designed to describe the early implementation of the MBCCOP and identify the challenges that have emerged in developing a network aimed at increasing the participation of minority populations in clinical trials. METHODS: Data were taken from primary and secondary sources, including site visits and patient log data, that described performance of 12 MBCCOP centers initially funded in September 1990. Accrual was measured by the number of credits earned per MBCCOP for patients enrolled in research protocols for cancer treatment or for prevention and control, which includes activities such as early detection, pain control, and rehabilitation. These accrual credits, assigned by the NCI, were based on the complexity of the protocol and the amount of resources expected to be required for accrual of patients by the MBCCOP. RESULTS: Data for the first 2 years of the MBCCOP showed that 344 patients were accrued to trials of treatment protocols from June 1, 1990, to May 31, 1991, and this number increased to 470 during the second accrual year, June 1, 1991, to May 31, 1992. Similarly, accrual of patients to cancer prevention and control studies increased from 256 in 1990-1991 to 423 in 1991-1992. More than 70% of the MBCCOP patients entered in studies were from minority populations. The proportion of eligible MBCCOP patients entered into treatment protocols was identical with that experienced by the initial Community Clinical Oncology Program (CCOP). Results also demonstrated that MBCCOP centers operate in an environment characterized by socio-economic decline and limited resources, both having substantial effects on the implementation of clinical trials among minorities. While minority patients are willing to participate in clinical trials, there are profound barriers involving language, logistics, and the appropriateness of available protocols. Participating physicians, nurses, and support personnel report a high level of agreement with program goals and have developed unique approaches to meeting the challenges faced in the implementation of this program. CONCLUSIONS: The MBCCOPs have demonstrated their ability to participate in clinical trials. Evaluation reveals, however, that they are emerging organizations influenced by factors endemic to the community they serve and their own structure. The MBCCOPs are confronting substantial challenges, yet they provide an important link to the overall NCI clinical trials network.

Aged↗
PubMed1980

An empirical definition of "primary care".

An operational definition of "primary care", useful to a wide variety of professionals, has eluded researchers since the term first gained popularity. This paper presents an activity-based definition of primary care derived from ratings of 59 representative health care activities by a group of state health administrators, a group of local health department directors, and a random sample of primary care physicians practicing in North Carolina. Thirty-one activities received ratings indicating they were considered core primary care services. Examination of differences in ratings among the three groups surveyed suggested that health department directors differ from the other two groups. Consideration of the variances of activity ratings within the groups emphasizes the unique response of the health department directors and identifies activities characterized by considerable disagreement. The study includes information necessary for researchers and practitioners to form an activity-based definition of varying scope. Definitions constructed from this information should be useful in planning the evaluation efforts that involve different groups of providers, since activities provide an objective basis for agreement. Repeating the approach outlined in the paper with other provider groups in other areas of the country should lead to better understanding of intergroup and regional differences in the concept of "primary care".

Attitude of Health Personnel↗
PubMed1979

Planning for management information systems in drug treatment organizations.

An attempt to set up a management information system for individual drug abuse programs throughout a state is described. The principles upon which the system is based are discussed along with the problems encountered in its implementation. A series of guidelines for establishing management information systems in operating human services agencies is included.

Administrative Personnel↗
PubMed1977

A practical reporting and evaluation system for intervention programs: guiding principles and potential uses.

The continued existence of intervention programs is contingent on the ability to answer basic questions such as "What is your program doing?" and "Why should we fund your program?" This paper outlines basic principles and describes a practical reporting and supplemental evaluation system that can be used by administrators of even the smallest intervention program.

Community Mental Health Services↗
PubMedDate not supplied

Competition and survival of health service organizations: a population ecology approach.

The survival of health care organizations is viewed, in this article, from a population ecology perspective. This perspective provides insight into how organizational forms are differentiated on the basis of resource availability under different environmental conditions. Selected hypotheses and a rationale are presented to illustrate the applicability of the perspective to health services.

Delivery of Health Care↗
PubMedDate not supplied

Community Clinical Oncology Program participation in the Breast Cancer Prevention Trial: factors affecting accrual.

Cancer prevention and control involves a diverse spectrum of activities that range from preventing the disease to providing rehabilitation to its survivors. The range of activities included within the definition of cancer prevention and control makes it difficult to determine factors that would predict accrual to specific cancer prevention and control trials. The participation of 36 CCOP organization in the National Cancer Institute-sponsored Breast Cancer PRevention TRial (BCPT) presented the opportunity to assess the ability of Community Clinical Oncology Program (CCOPs) to enroll subjects in one of the nation's first large-scale cancer prevention trials and to compare characteristics of CCOP accrual to the BCPT with factors associated with accrual by CCOPs to cancer treatment and other cancer prevention and control clinical trials. Although representing only 13% of participating health care organizations, CCOPs presently contribute nearly 30% of total BCPT accrual. Comparison of regression models representing accrual to treatment, cancer control, and chemoprevention (i.e., BCPT) protocols shows similar predictors between treatment and chemoprevention models. Cancer control models, however, did not share similar predictors. Thus, accrual to chemoprevention trials is associated, to a greater extent, with the characteristics that facilitate accrual to treatment trials rather than to cancer control trials. Results have implications for the planning and ongoing management of cancer treatment, control, and chemoprevention clinical trials.

Antineoplastic Agents↗