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. Author manuscript; available in PMC: 2013 May 8.
Published in final edited form as: J Health Care Poor Underserved. 2011 Feb;22(1):83–100. doi: 10.1353/hpu.2011.0023

Eliminating Disparities in Cancer Screening and Follow-up of Abnormal Results: What Will It Take?

Kevin Fiscella 1, Sharon Humiston 2, Samantha Hendren 3, Paul Winters 4, Pascal Jean-Pierre 5, Amna Idris 4, Patricia Ford 4
PMCID: PMC3647145  NIHMSID: NIHMS461909  PMID: 21317508

Abstract

Health and health care disparities related to cancer are a major public health problem in the United States. Providing care that is truly patient-centered could address disparities in cancer screening and follow-up through better alignment between patient needs and health care resources available to address those needs. Key health care reforms offer promise for doing so.

Keywords: Disparities, cancer screening, minority groups, income/poverty

Racial and ethnic minorities, particularly African Americans, have higher death rates from many types of cancer for which death is avoidable, including breast (BC), cervical (CC), and colorectal cancer (CRC).1 Higher incidences of cervical and colorectal cancer among poor and African American patients1 coupled with lower rates of cancer screening contribute to these disparities.2–4 Notably in the U.S., 47% of non-Hispanic Whites are up to date on CRC screening compared with 38% of Blacks.5 This is a classic example of the “inverse care law” whereby those at highest risk (Blacks) are less likely to be screened and treated.6 Disparities in cancer screening contribute to disparities in life expectancy.7 Cancer health disparities are further compounded by greater delays in diagnostic evaluation among minority patients with positive screening tests,8–10 and by suboptimal treatment among poor and minority patients diagnosed with cancer.11–14

In this paper, we first describe the key challenges to addressing racial and socioeconomic disparities in cancer screening and timely follow-up of abnormal screening test results. We then discuss the meaning of patient-centered care in terms of resource alignment, specific resources that are needed to address disparities through patient-centered care, and potential opportunities under health care reform to make this happen.

Patient-Centered Care and Resource Alignment

Patient-centered care became the mantra of health care reform in 2009–10, particularly in primary care.15 Implicit in the notion of patient-centered care is responsiveness to patient needs, preferences, and values.16 This notion suggests the need to align health care resources according to the needs of the patient, including addressing barriers to cancer screening and to ensuring informed patient decision-making. Yet, currently health care resources are poorly aligned with the needs of patients, particularly those who have low incomes and are members of minority groups.16 This mismatch is especially evident in under-resourced safety-net practices. Better alignment of health care resources with patient needs is necessary for eliminating disparities in cancer screening and follow-up. The concept of the Patient-Centered Medical Home (PCMH) reflects the need to re-organize primary care delivery around the needs of the patient rather than physician or practice.15 It provides greater potential than the current delivery model for aligning resources with patient needs.

Mismatch Between Patient Needs and Health Care Resources

Low-income patients and members of minority groups are more likely than others to lack adequate health care insurance, and lack of insurance is strongly associated with a lack of cancer screening.17 Latinos and low-income patients are more likely than others to lack any health insurance.18 Under-insurance is also problematic as evidenced by the fact that, in the United States, one of three primary care patients is underinsured, and half of these patients are unable to afford recommended care.19 Furthermore, race, ethnicity, and low income are associated with under-insurance.19 Insurance copayments for cancer prevention tend to discourage care, particularly for low-income patients,20 while patient financial incentives have been shown to be among the most effective strategies for increasing mammography.21

A number of local, state, and national programs have been implemented to support cancer screening for the uninsured and other low-income patients. A prominent example is the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and Colorectal Cancer Control Program (CRCCP), intended to address patient financial needs. Since 1991, the NBCCEDP has served more than three million women, paying for more than 7.2 million cancer screening examinations.22 However, this represents only a small portion of uninsured patients in need of screening.23 Despite an increasing number of uninsured patients, the number of screenings through the NBCCEDP declined between 2005 and 200724 (with a slight uptick in 2008). While this gap primarily reflects inadequate funding,25 it may also reflect lack of organized systems within primary care practices for referral of eligible patients to these NBCCEDP and similar programs.

Poor and minority patients also face non-financial barriers to cancer screening. Examples include limited knowledge,26,27 mistrust,28 limited English proficiency (LEP),29 low self efficacy,30–32 low health care literacy,33 and lack of a usual source of primary care.34 Unfortunately, primary care practices, even federally-qualified health centers, are often not sufficiently equipped to recognize and adequately address these problems.35 The basic structure of primary care presents a barrier to cancer screening because virtually all primary care is funneled through rushed 15-minute visits.36 Discussion of cancer screening is often deferred due to competing demands from acute problems.37,38 When cancer screening is discussed, there is often insufficient time for informed decision-making.39 Given the limited amount of face-to-face primary care physician-patient time, an organized approach to cancer screening that includes delegation of appropriate tasks to other team members may help.40,41

Mismatch Between Need and Resources in Safety Net Practices

The mismatch between patient needs and practice resources is great in practices serving poor and minority patients,42,43 in part due to low private physician reimbursements from Medicaid and limitations in payments to health centers.44,45 This mismatch between patient need and practice resources likely contributes to disparities in health care processes and outcomes.46 Minority and low-income patients experience less partnership in the patient-physician relationship,47 and less discussion of cancer screening48 and cancer treatment than non-minority, affluent patients.49 Many safety-net practices lack adequate health information technology (HIT) and sufficient patient navigators or other practice support personnel to assist with cancer screening activities.42,50 To diminish the disparities in cancer prevention, practices serving low-income and minority patients need these and other resources to better address their patients’ needs.36,41

In summary, the challenges to addressing disparities in cancer screening include (1) disproportionately high prevalence of lack of insurance and under-insurance among poor and minority patients, coupled with high rates of non-financial barriers; and (2) receipt of primary care in under-funded, safety-net practices that suffer from lower reimbursement from payers such as Medicaid, a lack of meaningful HIT to prompt and support providers’ efforts to encourage screening, and most importantly, primary care that is premised almost entirely on brief provider-driven face-to-face visits. (See Box 1.) In this setting, low-intensity interventions (e.g., single mailed reminder) to eligible patients may increase disparities in cancer screening because disadvantaged patients may respond at lower rates than those with more resources.51 The promise of more intensive existing programs to improve cancer screening for low-income and minority patients has not been realized because most patients who could benefit from them are not connected with them.

Box 1.

Challenges to Decreasing Disparities in Cancer Screening and Follow-up of Abnormal Screening Results

Patient Factors

  • Lack of insurance

  • Under-insurance and uncovered costs

  • Non-financial barriers

    • Lower levels of knowledge

    • Mistrust of health care

    • Limited English proficiency

    • Less self efficacy

    • Lower health literacy

    • Lack of a usual source of primary care
Practice Factors

  • Poor reimbursement for primary care, especially for publically insured patients who present at safety-net practices

  • Competing demands during 15-minute visits

  • Lack of resources to support team-based care such as patient navigators or community health workers

  • Lack of adequate health information technology

  • Lack of systems for referring uninsured patients to screening promotion programs (e.g., NBCCEDP)
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The Promise of Health Care Reform

The passage of health care reforms, particularly the Patient Protection and Affordable Care Act, commonly shortened to the Affordable Care Act (ACA) may enhance resources to address disparities in cancer screening and follow-up by better aligning resources according to patients’ needs. The ACA is a complex bill and some of the key provisions are as yet unfunded. Box 2 highlights the changes needed at various levels (patient, practice, community, research, and training) to address disparities in cancer screening and follow-up; some of the key corresponding health reforms that address these needs; and gaps that are likely to remain.

Box 2.

Potential of Healthcare Reform to Decrease Disparities in Cancer Screening and Follow-up of Abnormal Tests

Type of need Relevant health care reform provisions Gaps remaining
PATIENT LEVEL
Affordability/ Financial/ access

  • Expansion of health insurance coverage for up to 32 million persons.

  • Elimination of cost sharing by Medicare, Medicaid, and qualified health plans for cancer screening (those receiving an A or B rating by the USPSTF) and waive the Medicare deductible for colorectal cancer screening.

  • Expand programs for cancer screening for the poor (eg, NBCCEDP).

  • Double capacity of community health centers to 40 million.

  • Establishes the National Prevention, Health Promotion, and Public Health Council to coordinate federal prevention and wellness activities.

  • Create a Prevention and Public Health Fund to sustain/expand public health (including screenings)

  • Up to 23 million uninsured (Congressional Budget Office estimate)

  • Inadequate funding for NBCCDEP and NCRCCP (for remaining uninsured)

  • Cost sharing for diagnostic evaluations (and treatment)

  • Loss time for work (due to inconvenient health care hours for screening and diagnostic evaluation)

  • Continued tyranny of 15- minute visit (inadequate time for patients with low health literacy, limited English Proficiency, mistrust, culture).
Lack of education Cultural beliefs/trust Language Low health literacy

  • Support for wellness programs for small employers

  • Support for cultural competency training

  • Expansion of community health centers

  • Require enhanced collection of race, ethnicity, primary language and disability status, and undeserved rural and frontier populations (to enhance monitoring of disparities)

  • Establishes Community-Based Collaborative Care Network Program (CBCCNP) to support consortiums of providers to coordinate and integrate health care for uninsured and underinsured patients (outreach, case management, transportation, capacity)

  • PRACTICE LEVEL

  • High patient need within safety net practices

  • Team-based care

  • Tracking systems

  • Progressively intensive outreach

  • Patient-centered communication

  • Parity in Medicaid and Medicare payments for primary care 2013 and 2014.

  • Provide a 10% Medicare bonus to primary physicians Provide States the option of enrolling Medicaid beneficiaries with chronic conditions into health homes.

  • Shared Medicare savings for accountable health care organizations (that include primary care offices)

  • Establishment of standards for EMR vendors

  • ARRA subsidies for EMR adoption

  • Medicare bonuses for “meaningful use”

  • Reimbursement primarily limited to face-to-face office visits (with limited support for organized systems of care)

  • No direct funding for primary care- based outreach activities, navigators, health education.

  • No adjustment in funding based on social risk of patient population (alignment of resources with patient need)
COMMUNITY LEVEL
Improved coordination of care for underserved at community level

  • Establishes CBCCNP to support consortiums of providers to coordinate and integrate health care for uninsured and underinsured patients.

  • Establishes the National Prevention, Health Promotion, and Public Health Council to coordinate federal prevention and wellness activities.

  • Creates a Prevention and Public Health Fund to sustain/expand public health (including screenings) at the community level.

  • Shared Medicare savings for accountable health care organizations (that include primary care offices)

  • Inadequate funding for incentives for health information exchanges or Regional health information organizations needed to track cancer screening and follow-up across practices.
RESEARCH
Evidence regarding primary care and cancer screening best practices

  • Support public health research through Prevention and Public Health Funding

  • Limited funding for implementation research (e.g., establish effective cancer screening programs in practice)

  • NIH/AHRQ/CDC - Support for practice-based- research networks infrastructure to enable evaluation of new care model designed to facilitate screening and follow-up
TRAINING
Train new and existing physicians and nurses in new models of team- based preventive care

  • Increases in Graduate Medical Education (GME) positions in primary care

  • Establishes Teaching Health Centers (community-based, ambulatory training) including federally qualified health centers.

  • Establishes a Primary Care Extension program to assist primary care providers dissemination and implementation of innovations and best practices.

  • Develop and support training for existing practitioners as per the cooperative extension service model

  • Support grants to providers in states with shortages

  • Promote cultural competency training

  • Increase nursing training programs and capacity

  • Grants for nurse practitioners working in community health centers and for nurse-run clinics.

  • Establishes a national health care workforce commission to make recommendations to Congress

  • Team-based care and other models that support organized systems for preventive care into medical and nursing training programs.

  • No corresponding funding authorized for Primary Care Extension Program
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Key patient needs—minimizing cost and other barriers

The ACA is expected to reduce the number of people who are uninsured in the U.S by 32 million.52 In addition, legislation will eliminate patient cost sharing for evidence-based preventive services including breast, cervical and colorectal cancer covered by Medicare and Medicaid. These changes will not entirely eliminate cost barriers to cancer screening, particularly for low-income persons. Examples of common cost barriers include the need to pay annual insurance deductibles before any health care costs are covered, as well as for follow-up diagnostic testing, and treatment. These costs tend to accentuate cancer screening disparities.20 Optimally, payers would exclude cancer follow-up testing from required health plan co-payments and deductibles. Given the complex mix of health care plans in the U.S., it seems unlikely that consensus on this issue will emerge soon. Because as many as 23 million persons will remain uninsured or have gaps in coverage,53 there will be continuing need for programs such as the NBCCEDP to pay for cancer screening for low-income persons, whether they are among the underinsured or the remaining uninsured. The community-based Collaborative Care Network Program may help. It is intended to support local consortiums of health care providers (including health centers) to coordinate and integrate healthcare services -- including outreach, case management, transportation, and expanded health care capacity -- for low-income uninsured as well as underinsured populations. These programs could support establishment of community-wide cancer screening registries analogous to community-wide immunizations registries. They could also fund community outreach workers to contact unscreened patients and those who have have failed to obtain appropriate follow-up testing.

Key practice needs: resources practices need

All practices, particularly safety-net practices, require the resources to implement evidence-based approaches to screening promotion and follow-up.21,41 Transformation of primary care from brief face-to-face visits to team-based, organized systems of care provided through a variety of means as envisioned by the PCMH will likely facilitate this process. New forms of funding, through either coordination fees (e.g., patient per month payments) or performance bonuses for cancer screening, offer better means for aligning resources with patient needs than traditional visit-based fees. These payments could help support three specific types of resources needed to address cancer screening and follow-up disparities better: tracking systems, progressively intensive outreach, and patient-centered communication.

Tracking systems—identification of patients needing screening and follow-up

Addressing disparities in cancer screening requires the ability to identify patients whose screening status is not up-to-date. Therefore, safety net practices need adequate health information technology (HIT) that supports identification of patients in need of screening in order to facilitate both reaching out to patients and prompting the health care team at the point of care.54 Funding through the American Recovery Re-investment Act of 2009, provides physicians with financial incentives through Medicaid or Medicare for acquiring and engaging in meaningful use of HIT. Adequate HIT requires more than hardware and software; it requires support for personnel who input data, clean it, and use it to improve care including outreach through letters or phone calls (either personal or automated). Incentives for meaningful use could help offset these costs.

The details matter in designing HIT that will actually improve evidence-based practice, including cancer screening. HIT should support population management—particularly outreach to unscreened patients.55 Systems need user-friendly patient registry capabilities in order to do this, and current systems often lack this feature.41,56 Tracking systems should be able to identify patients in need of screening from an entire population of eligible patients seen in the practice and track patients through follow-up of abnormal results.56,57 Linkage to mail merge or automated telephone reminders can reduce work loads.58,59 The system should also facilitate referral to the NBCCEDP or CRCCP for uninsured patients. Where clinician prompts are built into HIT systems, they must be carefully designed, because clinicians may ignore electronic cancer screening alerts, particularly if they believe they are not reliable or if they are confronted daily by too many alerts.60,61

Increasingly intensive outreach

Increasingly intensive outreach helps reach the most marginalized patients. One time telephone or mailed reminders alone may not suffice for all patients nor eliminate disparities in cancer screening due to greater access barriers. 51 Instead, multimodal,21 increasingly intensive outreach by trained staff (e.g., navigators) may be needed,62,63 for unscreened patients who have not yet responded and for patients with abnormal results requiring testing and/or treatment. This outreach could be supported by Collaborative Care Network programs or through additional payments streams for PCMHs, e.g. care coordination fees or performance bonuses for improved cancer screening and follow-up.

Safety-net practices specifically require changes in reimbursement (e.g., alternatives/supplements to visit-based payments) and training to support team-based approaches to cancer screening, including use of patient navigators/community health workers for outreach and education.36 A progressively intensive approach (e.g., point-of-care prompts, letters, personal phone calls, and -- as a last resort -- home visits) using community health workers has been shown to virtually eliminate community wide disparities in childhood immunizations.64 A similar approach involving creation of registry and use of navigators has been used to eliminate disparities in completed oncology consultations for breast cancer.65

Once patients in need of screening have been identified, contacting these patients and delivering an effective message that promotes screening behavior is the next challenge. Tailored or personalized reminders that communicate to the patient when s/he was last screened appear to be most effective, particularly when coupled with physician recommendation for screening.66–69

Patient-centered communication

Cancer screening decision-making requires consideration of benefits (e.g., early cancer detection and/or prevention) and risks, (e.g., the discomfort and costs of screening, risk for false positives, and complications associated with treatment) in the context of patient preferences, values, and health literacy. Informed patient decision-making is facilitated by adequate time, establishment of trusting relationship, clear explanations, elicitation of patient values and preferences, and confirmation of understanding using principles of patient-centered communication and cultural competency.70,71 Motivational interviewing72 can be helpful particularly if patients’ screening preferences are considered.73 Matching colorectal cancer screening modality (e.g., colonoscopy, home testing kit) to patients’ screening preference increases screening rates.74 Adequate time, training, and culturally competent staff are needed for these discussions.71,75 Potentially, these discussions could be delegated to appropriately trained nurses. Payment reforms may facilitate these innovations by shifting care from time-pressured visits packed with too many tasks provided exclusively by clinicians (under fee-for-service visits) to care provided by different team members through a range of modalities (e.g., phone, mail, email, text, home visits).

Support for practices under health care reform

Health care reform, particularly ACA, ushers in substantially more funding for community health centers, potentially doubling the number of patients served. In addition, support through the Prevention and Public Health Fund will promote integration of primary care services into publicly-funded community-based behavioral health settings, and bolster local, state and tribal public health infrastructure, possibly improving opportunities to screen and treat hard-to-reach patients for cancer.

The ACA will provide bonus payments to primary care physicians under Medicare (with additional bonuses for primary care physicians working in professional shortage areas). It also eliminates differences in payments between Medicaid and Medicare for primary care. This may begin to minimize disparities in resources between primary care practices whose patient populations differ widely by social disadvantage.

Optimally, future payment reform would direct more resources to practices that serve groups with high needs, (e.g., high rates of poverty, low health literacy, low English proficiency).76 Potential strategies include expanded federal funding for enabling services from such personnel as community health workers, patient navigators, and interpreters, and development of separate billing codes for these services.36,77 As payers move towards bundled payments, it will be critical that such payments not only account for case-mixes based on traditional measures of medical morbidity, but also based on social risk.78

Health information technologies

Health information technologies (HIT)—including electronic medical records that are truly useful to clinicians—are central to primary care79–81 and improved cancer screening.82 The combination of federal HIT leadership, subsidies for HIT, and physician bonuses for meaningful use may accelerate HIT adoption in primary care.83,84 However, several additional challenges must be addressed if HIT is to substantively improve cancer screening and reduce disparities.84 Specifically, commercially available HIT systems must be designed to minimize clinician and staff workload while promoting clinical decision support and population management (e.g., registry functions).85 Hand-held electronic devices are becoming increasingly user-friendly, and HIT systems for primary care should be as easy to use as these. Ease of use includes minimization of manual data entry. For example, systems must have the capability of electronically importing and sorting screening data. Connectivity between systems is of central importance. Normal results should trigger future prompts at the appropriate intervals. Abnormal results should trigger alerts and tracking systems until care is completed. Systems should contain sufficient data to provide tailored reminders to patients.86 In addition, incentives for cancer screening and/or documentation of informed cancer decision-making are needed to promote meaningful use of HIT.

Support for the patient-centered medical home

Health care reform takes small steps towards creation of PCMHs.87 The PCMH concept is intended to provide key infrastructure such as (a) payment reforms necessary to support new care models that include optimal use of HIT, (b) team-based care, and (c) implementation of evidence-based approaches to screening promotion.15,21 These elements are related. For example, new payment models could create opportunities to implement team-based care. Health care teams offer promise for improvement in efficiency while also increasing diversity and cultural competency, and time spent with patients.88,89 Reimbursement under PCMH should take into account patient needs when establishing per patient payments.15 This could help better align practice resources with patient needs and facilitate implementation of organized systems for cancer screening and follow-up. Health reform begins this process by providing States with the option of enrolling Medicaid beneficiaries with chronic conditions and those enrolling in health insurance exchanges into a health homes designed to facilitate care coordination. In addition, in 2011 some States will begin providing primary care practices with bonus Medicaid payments based on PCMH criteria established through the National Commission on Quality Assurance (NCAQ).90

Current NCQA PMCH criteria require documentation of systematic tracking of test results, and abnormal results and referrals. Proposed NCQA criteria for 2011 would likely further facilitate cancer screening and follow-up for underserved patients. These include requirements for culturally linguistically appropriate services, organized systems of care (e.g., standing orders for preventive care, delegation of tasks within care team, care team training to communicate with vulnerable patients), searchable data (including cancer screening), use of data for population management (including cancer screening), use of systems to track referrals to community services (e.g., NBCCEDP), and quality improvement including setting goals and taking action to improve care to vulnerable populations.91 Thus, expansion in the number of states offering Medicaid bonuses for establishment of PCMH could have a significant impact over time in disparities in cancer screening and follow-up.

Change in health services research funding and medical training

The NIH Director, Francis Collins, has made research related to health care reform a high priority.92 Optimally, this would include research needed to guide implementation of the PCMH, including research related to improving cancer screening in primary care practices.41

The ACA increases funding for training in primary care sites, including federally-qualified health centers. Effective implementation of the PCMH requires new training models for both medical undergraduate and graduate education, in addition to training for community physicians, particularly those working in underserved practices. Currently, medical school and residency program primary care training is constrained by fee-for-service payment for 15-minute face-to-face visits.36 There is an urgent need to motivate medical schools to develop new care models, particularly team-based delivery of preventive care including cancer screening.41 There is also need for training community clinicians currently in practice.83 Promising examples include the Health Disparities Collaborative sponsored by the Health Resources Services Administration and the cooperative extension service model that fosters community learning collaboratives.83,93

Conclusions

There is mounting evidence of the need for and value of organized approaches to cancer screening (e.g., use of registries to identify unscreened patients, delegation of tasks, outreach through letters and/or phone, point of care reminders);94 organized approaches are critical to addressing disparities in cancer screening and follow-up.95,96 The central barriers to implementing these evidence-based interventions are lack of resources, particularly in practices that serve poor and minority patients, but also a need for redesign of primary care away from exclusively visit-based care and towards team-based care.42,97,98

Health care reform—whether radical or incremental—extends the possibility of improved coverage for the uninsured, diffusion of HIT into primary care practices, small steps towards the PCMH, funding for relevant research and training, and potentially greater resources for safety net providers. Each of these could help in better aligning resources according to patients’ needs. The extent to which health care reform succeeds in doing so may determine how successfully disparities in cancer screening and follow-up are reduced.

Acknowledgments

American Cancer Society (RSGT-08-077-01) and National Cancer Institute/NIH (NCI/NIH U01CA116924-01). We thank Adjuah van Keken for assistance in preparing this manuscript.

Footnotes

Financial Disclosures

None of the authors report any financial interest in matters covered in this paper.

References

  • 1.Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin. 2009 Jul;59(4):225–49. doi: 10.3322/caac.20006. [DOI] [PubMed] [Google Scholar]
  • 2.Ioannou GN, Chapko MK, Dominitz JA. Predictors of colorectal cancer screening participation in the United States. Am J Gastroenterol. 2003 Sep;98(9):2082–91. doi: 10.1111/j.1572-0241.2003.07574.x. [DOI] [PubMed] [Google Scholar]
  • 3.Smith-Bindman R, Miglioretti DL, Lurie N, et al. Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med. 2006 Apr;144(8):541–53. doi: 10.7326/0003-4819-144-8-200604180-00004. [DOI] [PubMed] [Google Scholar]
  • 4.Fiscella K, Holt K, Meldrum S, et al. Disparities in preventive procedures: comparisons of self report and Medicare claims data. BMC Health Serv Res. 2006;6:122. doi: 10.1186/1472-6963-6-122. http://www.biomedcentral.com/content/pdf/1472-6963-6-122.pdf. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Fenton JJ, Tancredi DJ, Green P, et al. Persistent racial and ethnic disparities in up-to-date colorectal cancer testing in medicare enrollees. J Am Geriatr Soc. 2009 Mar;57(3):412–8. doi: 10.1111/j.1532-5415.2008.02143.x. [DOI] [PubMed] [Google Scholar]
  • 6.Hart JT. The inverse care law. Lancet. 1971 Feb;1(7696):405–12. doi: 10.1016/s0140-6736(71)92410-x. [DOI] [PubMed] [Google Scholar]
  • 7.Wong MD, Ettner SL, Boscardin WJ, et al. The contribution of cancer incidence, stage at diagnosis and survival to racial differences in years of life expectancy. J Gen Intern Med. 2009 Apr;24(4):475–81. doi: 10.1007/s11606-009-0912-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Strzelczyk JJ, Dignan MB. Disparities in adherence to recommended followup on screening mammography: interaction of sociodemographic factors. Ethn Dis. 2002;12(1):77–86. [PubMed] [Google Scholar]
  • 9.Gwyn K, Bondy ML, Cohen DS, et al. Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer. 2004 Apr;100(8):1595–604. doi: 10.1002/cncr.20169. [DOI] [PubMed] [Google Scholar]
  • 10.Elmore JG, Nakano CY, Linden HM, et al. Racial inequities in the timing of breast cancer detection, diagnosis, and initiation of treatment. Med Care. 2005 Feb;43(2):141–8. doi: 10.1097/00005650-200502000-00007. [DOI] [PubMed] [Google Scholar]
  • 11.Lurie JD, Welch HG. Diagnostic testing following fecal occult blood screening in the elderly. J Natl Cancer Inst. 1999 Oct;91(19):1641–6. doi: 10.1093/jnci/91.19.1641. [DOI] [PubMed] [Google Scholar]
  • 12.Baig N, Myers RE, Turner BJ, et al. Physician-reported reasons for limited follow-up of patients with a positive fecal occult blood test screening result. Am J Gastroenterol. 2003 Sep;98(9):2078–81. doi: 10.1111/j.1572-0241.2003.07575.x. [DOI] [PubMed] [Google Scholar]
  • 13.Bickell NA, Wang JJ, Oluwole S, et al. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol. 2006 Mar;24(9):1357–62. doi: 10.1200/JCO.2005.04.5799. [DOI] [PubMed] [Google Scholar]
  • 14.Griggs JJ, Sorbero ME, Stark AT, et al. Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Res Treat. 2003 Sep;81(1):21–31. doi: 10.1023/A:1025481505537. [DOI] [PubMed] [Google Scholar]
  • 15.Kellerman R, Kirk L. Principles of the patient-centered medical home. Am Fam Physician. 2007 Sep;76(6):774–5. [PubMed] [Google Scholar]
  • 16.Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001. [PubMed] [Google Scholar]
  • 17.Robinson JM, Shavers V. The role of health insurance coverage in cancer screening utilization. J Health Care Poor Underserved. 2008 Aug;19(3):842–56. doi: 10.1353/hpu.0.0048. [DOI] [PubMed] [Google Scholar]
  • 18.Mead H, Cartwright-Smith L, Jones K, et al. Racial and Ethnic Disparities in US Health Care: A Chartbook. Washington, D.C: Commwealth Foundation; Racial and Ethnic Disparitiesin U.S. Health Care: A ChartbookHolly Mead, Lara Cartwright-Smith, Karen Jones, Christal Ramos, Kristy Woods, and Bruce Siegel, Page 2. [Google Scholar]
  • 19.Voorhees K, Fernald DH, Emsermann C, et al. Underinsurance in primary care: a report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP) Journal of the American Board of Family Medicine: JABFM. 2008 Jul;21(4):309–16. doi: 10.3122/jabfm.2008.04.080001. [DOI] [PubMed] [Google Scholar]
  • 20.Trivedi AN, Rakowski W, Ayanian JZ. Effect of cost sharing on screening mammography in Medicare health plans. N Engl J Med. 2008 Jan;358(4):375–83. doi: 10.1056/NEJMsa070929. [DOI] [PubMed] [Google Scholar]
  • 21.Stone EG, Morton SC, Hulscher ME, et al. Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Intern Med. 2002 May;136(9):641–51. doi: 10.7326/0003-4819-136-9-200205070-00006. [DOI] [PubMed] [Google Scholar]
  • 22.Khan K, Curtis CR, Ekwueme DU, et al. Preventing cervical cancer : overviews of the National Breast and Cervical Cancer Early Detection Program and 2 US immunization programs. Cancer. 2008 Nov;113(10:Suppl):Suppl-12. doi: 10.1002/cncr.23765. [DOI] [PubMed] [Google Scholar]
  • 23.Tangka FK, Dalaker J, Chattopadhyay SK, et al. Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002–2003 (United States) Cancer Cause Control. 2006 Nov;17(9):1145–54. doi: 10.1007/s10552-006-0058-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Centers for Disease Control and PreventionCenters for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program (NBCCEDP): About the Program. [Google Scholar]
  • 25.Government Accountability OfficeGovernment Accountability Office. Source of Screening Affects Women’s Eligibility for Coverage of Breast and Cervical Cancer Treatment in Some States. [Google Scholar]
  • 26.Lannin DR, Mathews HF, Mitchell J, et al. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998;279:1801–7. doi: 10.1001/jama.279.22.1801. [DOI] [PubMed] [Google Scholar]
  • 27.Margolis ML, Christie JD, Silvestri GA, et al. Racial differences pertaining to a belief about lung cancer surgery: results of a multicenter survey. Annals Intern Med. 2003 Oct;139(7):558–63. doi: 10.7326/0003-4819-139-7-200310070-00007. [DOI] [PubMed] [Google Scholar]
  • 28.Doescher MP, Saver BG, Franks P, et al. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000 Nov;9(10):1156–63. doi: 10.1001/archfami.9.10.1156. [DOI] [PubMed] [Google Scholar]
  • 29.Fiscella K, Franks P, Doescher MP, et al. Disparities in health care by race, ethnicity, and language among the insured findings from a national sample. Med Care. 2002 Jan;40(1):52–9. doi: 10.1097/00005650-200201000-00007. [DOI] [PubMed] [Google Scholar]
  • 30.Clark DO, Patrick DL, Grembowski D, et al. Socioeconomic status and exercise self-efficacy in late life. J Behav Med. 1995 Aug;18(4):355–76. doi: 10.1007/BF01857660. [DOI] [PubMed] [Google Scholar]
  • 31.Kempen GI, Jelicic M, Ormel J. Personality, chronic medical morbidity, and health-related quality of life among older persons. Health Psychol. 1997 Nov;16(6):539–46. doi: 10.1037//0278-6133.16.6.539. [DOI] [PubMed] [Google Scholar]
  • 32.Sarkar U, Fisher L, Schillinger D. Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care. 2006 Apr;29(4):823–9. doi: 10.2337/diacare.29.04.06.dc05-1615. [DOI] [PubMed] [Google Scholar]
  • 33.Bennett IM, Chen J, Soroui JS, et al. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009 May;7(3):204–11. doi: 10.1370/afm.940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Bindman AB, Grumbach K, Osmond D, et al. Primary care and receipt of preventive services. JGIM. 1996;11(5):269–76. doi: 10.1007/BF02598266. [DOI] [PubMed] [Google Scholar]
  • 35.Grumbach K, Bodenheimer T. A primary care home for Americans: putting the house in order. JAMA. 2002 Aug;288(7):889–93. doi: 10.1001/jama.288.7.889. [DOI] [PubMed] [Google Scholar]
  • 36.Fiscella K, Epstein RM. So much to do, so little time: care for the socially disadvantaged and 15-minute visits. Arch Intern Med. 2008 doi: 10.1001/archinte.168.17.1843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Jaen CR, Stange KC, Nutting PA. Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract. 1994;38(2):166–71. [PubMed] [Google Scholar]
  • 38.Nutting PA, Baier M, Werner JJ, et al. Competing demands in the office visit: what influences mammography recommendations? J Am Board Fam Pract. 2001 Sep;14(5):352–61. [PubMed] [Google Scholar]
  • 39.Ling BS, Trauth JM, Fine MJ, et al. Informed decision-making and colorectal cancer screening: is it occurring in primary care? Med Care. 2008 Sep;46(9:Suppl 1):Suppl-9. doi: 10.1097/MLR.0b013e31817dc496. [DOI] [PubMed] [Google Scholar]
  • 40.Frame PS. Automated health maintenance reminders: tools do not make a system. J Am Board Fam Pract. 2003 Jul;16(4):350–1. doi: 10.3122/jabfm.16.4.350. [DOI] [PubMed] [Google Scholar]
  • 41.Klabunde CN, Lanier D, Breslau ES, et al. Improving colorectal cancer screening in primary care practice: innovative strategies and future directions. J Gen Intern Med. 2007 Aug;22(8):1195–205. doi: 10.1007/s11606-007-0231-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Varkey AB, Manwell LB, Williams ES, et al. Separate and unequal: clinics where minority and nonminority patients receive primary care. Arch Intern Med. 2009 Feb;169(3):243–50. doi: 10.1001/archinternmed.2008.559. [DOI] [PubMed] [Google Scholar]
  • 43.Bach PB, Pham HH, Schrag D, et al. Primary care physicians who treat blacks and whites. N Engl J Med. 2004 Aug;351(6):575–84. doi: 10.1056/NEJMsa040609. [DOI] [PubMed] [Google Scholar]
  • 44.Cunningham PJ, O’Malley AS. Do reimbursement delays discourage Medicaid participation by physicians? Health Aff. 2009 Jan;28(1):w17–w28. doi: 10.1377/hlthaff.28.1.w17. [DOI] [PubMed] [Google Scholar]
  • 45.Shin P, Ku L, Jones E, Finnegan B, Rosenbaum S, Shin P, Ku L, Jones E, Finnegan B, Rosenbaum S. Financing Community Health Centers as Patient and Community Centered Medical Homes: A Primer [Google Scholar]
  • 46.AHRQAHRQ. National Healthcare Quality & Disparities Reports. 2009. [Google Scholar]
  • 47.Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282(6):583–9. doi: 10.1001/jama.282.6.583. [DOI] [PubMed] [Google Scholar]
  • 48.Bao Y, Fox SA, Escarce JJ. Socioeconomic and racial/ethnic differences in the discussion of cancer screening: “between-“ versus “within-“ physician differences. Health Serv Res. 2007 Jun;42(3 Pt 1):t-70. doi: 10.1111/j.1475-6773.2006.00638.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Gordon HS, Street RL, Jr, Sharf BF, et al. Racial differences in doctors’ information-giving and patients’ participation. Cancer. 2006 Sep;107(6):1313–20. doi: 10.1002/cncr.22122. [DOI] [PubMed] [Google Scholar]
  • 50.Hing E, Burt CW. Are there patient disparities when electronic health records are adopted?. J Health Care Poor Underserved. 2009 May;20(2):473–88. doi: 10.1353/hpu.0.0143. [DOI] [PubMed] [Google Scholar]
  • 51.Spadea T, Bellini S, Kunst A, et al. The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: A review. Prev Med. 2010 doi: 10.1016/j.ypmed.2010.01.007. In Press, Corrected Proof. [DOI] [PubMed] [Google Scholar]
  • 52.McWilliams JM, Zaslavsky AM, Meara E, et al. Impact of Medicare coverage on basic clinical services for previously uninsured adults. JAMA. 2003 Aug;290(6):757–64. doi: 10.1001/jama.290.6.757. [DOI] [PubMed] [Google Scholar]
  • 53.Congressional Budget OfficeCongressional Budget Office. Table 2. Preliminary Estimate of the Effects of Insurance Coverage Provisions on the Reconciliation Legislative Combined with H.R. 3590 as Passed by the Senate.
  • 54.Shekelle PG, Morton SC, Keeler EB. Costs and benefits of health information technology. Evid Rep Technol Assess. 2006 Apr;(132):1–71. doi: 10.23970/ahrqepcerta132. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Frame PS. Can computerized reminder systems have an impact on preventive services in practice? J Gen Intern Med. 1990 Sep;5(5:Suppl):Suppl-5. doi: 10.1007/BF02600855. [DOI] [PubMed] [Google Scholar]
  • 56.Taplin SH, Rollason D, Camp A, et al. Imagining an Electronic Medical Record for Turning Cancer Screening Knowledge into Practice. Am J Prev Med. 2010 Jan;38(1):89–97. doi: 10.1016/j.amepre.2009.09.037. [DOI] [PubMed] [Google Scholar]
  • 57.Frame PS. Computerized health maintenance tracking systems: a clinician’s guide to necessary and optional features. A report from the American Cancer Society Advisory Group on Preventive Health Care Reminder Systems. J Am Board Fam Pract. 1995 May;8(3):221–9. [PubMed] [Google Scholar]
  • 58.Feldstein AC, Perrin N, Rosales AG, et al. Effect of a multimodal reminder program on repeat mammogram screening. Am J Prev Med. 2009 Aug;37(2):94–101. doi: 10.1016/j.amepre.2009.03.022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 59.DeFrank JT, Rimer BK, Gierisch JM, et al. Impact of mailed and automated telephone reminders on receipt of repeat mammograms: a randomized controlled trial. Am J Prev Med. 2009 Jun;36(6):459–67. doi: 10.1016/j.amepre.2009.01.032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Sequist TD, Zaslavsky AM, Marshall R, et al. Patient and physician reminders to promote colorectal cancer screening: a randomized controlled trial. Arch Intern Med. 2009 Feb;169(4):364–71. doi: 10.1001/archinternmed.2008.564. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Schellhase KG, Koepsell TD, Norris TE. Providers’ reactions to an automated health maintenance reminder system incorporated into the patient’s electronic medical record. J Am Board Fam Pract. 2003 Jul;16(4):312–7. doi: 10.3122/jabfm.16.4.312. [DOI] [PubMed] [Google Scholar]
  • 62.Crane LA, Leakey TA, Ehrsam G, et al. Effectiveness and cost-effectiveness of multiple outcalls to promote mammography among low-income women. Cancer Epidemiol Biomarkers Prev. 2000 Sep;9(9):923–31. [PubMed] [Google Scholar]
  • 63.Dietrich AJ, Tobin JN, Cassells A, et al. Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Ann Intern Med. 2006 Apr;144(8):563–71. doi: 10.7326/0003-4819-144-8-200604180-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64.Szilagyi PG, Schaffer S, Shone L, et al. Reducing geographic, racial, and ethnic disparities in childhood immunization rates by using reminder/recall interventions in urban primary care practices. Pediatrics. 2002 Nov;110(5):e58. doi: 10.1542/peds.110.5.e58. [DOI] [PubMed] [Google Scholar]
  • 65.Bickell NA, Shastri K, Fei K, et al. A tracking and feedback registry to reduce racial disparities in breast cancer care. J Nat Cancer Institute. 2008 Dec;100(23):1717–23. doi: 10.1093/jnci/djn387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66.Sohl SJ, Moyer A. Tailored interventions to promote mammography screening: a meta-analytic review. Prev Med. 2007 Oct;45(4):252–61. doi: 10.1016/j.ypmed.2007.06.009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67.Ling BS, Schoen RE, Trauth JM, et al. Physicians encouraging colorectal screening: a randomized controlled trial of enhanced office and patient management on compliance with colorectal cancer screening. Arch Intern Med. 2009 Jan;169(1):47–55. doi: 10.1001/archinternmed.2008.519. [DOI] [PubMed] [Google Scholar]
  • 68.Percac-Lima S, Grant RW, Green AR, et al. A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. J Gen Intern Med. 2009 Feb;24(2):211–7. doi: 10.1007/s11606-008-0864-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 69.Han HR, Lee JE, Kim J, et al. A meta-analysis of interventions to promote mammography among ethnic minority women. Nurs Res. 2009 Jul;58(4):246–54. doi: 10.1097/NNR.0b013e3181ac0f7f. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 70.Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA. 2009 Oct;302(15):1685–92. doi: 10.1001/jama.2009.1498. [DOI] [PubMed] [Google Scholar]
  • 71.Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008 Nov;100(11):1275–85. doi: 10.1016/s0027-9684(15)31505-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72.Wahab S, Menon U, Szalacha L. Motivational interviewing and colorectal cancer screening: a peek from the inside out. Patient Educ Couns. 2008 Aug;72(2):210–7. doi: 10.1016/j.pec.2008.03.023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 73.Hawley ST, Volk RJ, Krishnamurthy P, et al. Preferences for colorectal cancer screening among racially/ethnically diverse primary care patients. Med Care. 2008 Sep;46(9 Suppl 1):S10–S16. doi: 10.1097/MLR.0b013e31817d932e. [DOI] [PubMed] [Google Scholar]
  • 74.Myers RE, Hyslop T, Sifri R, et al. Tailored navigation in colorectal cancer screening. Med Care. 2008 Sep;46(9:Suppl 1):Suppl-31. doi: 10.1097/MLR.0b013e31817fdf46. [DOI] [PubMed] [Google Scholar]
  • 75.Woolf SH, Chan EC, Harris R, et al. Promoting informed choice: transforming health care to dispense knowledge for decision making. Ann Intern Med. 2005 Aug;143(4):293–300. doi: 10.7326/0003-4819-143-4-200508160-00010. [DOI] [PubMed] [Google Scholar]
  • 76.Fiscella K, Shin P. The inverse care law: implications for healthcare of vulnerable populations. J Ambulatory Care Manage. 2005 Oct;28(4):304–12. doi: 10.1097/00004479-200510000-00005. [DOI] [PubMed] [Google Scholar]
  • 77.Shi L, Collins PB, Aaron KF, et al. Health center financial performance: national trends and state variation, 1998–2004. J Public Health Manag Pract. 2007 Mar;13(2):133–50. doi: 10.1097/00124784-200703000-00009. [DOI] [PubMed] [Google Scholar]
  • 78.Wang CJ, Conroy KN, Zuckerman B. Payment reform for safety-net institutions --improving quality and outcomes. N Engl J Med. 2009 Nov;361(19):1821–3. doi: 10.1056/NEJMp0907656. [DOI] [PubMed] [Google Scholar]
  • 79.Bodenheimer T, Grumbach K. Electronic technology: a spark to revitalize primary care? JAMA. 2003 Jul;290(2):259–64. doi: 10.1001/jama.290.2.259. [DOI] [PubMed] [Google Scholar]
  • 80.Mort EA, Edwards JN, Emmons DW, et al. Physician response to patient insurance status in ambulatory care clinical decision-making. Implications for quality of care. Med Care. 1996 Aug;34(8):783–97. doi: 10.1097/00005650-199608000-00006. [DOI] [PubMed] [Google Scholar]
  • 81.Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med. 2009 Apr;360(15):1477–9. doi: 10.1056/NEJMp0901592. [DOI] [PubMed] [Google Scholar]
  • 82.Nagykaldi Z, Mold JW. The Role of Health Information Technology in the Translation of Research into Practice: An Oklahoma Physicians Resource/Research Network (OKPRN) Study. Journal of the American Board of Family Medicine: JABFM. 2007 Mar;20(2):188–95. doi: 10.3122/jabfm.2007.02.060084. [DOI] [PubMed] [Google Scholar]
  • 83.Grumbach K, Mold JW. A health care cooperative extension service: transforming primary care and community health. JAMA. 2009 Jun;301(24):2589–91. doi: 10.1001/jama.2009.923. [DOI] [PubMed] [Google Scholar]
  • 84.Cunningham R. Stimulus bill implementation: expanding meaningful use of health IT. NHPF Issue Brief. 2009 Aug 25;(834):1–16. [PubMed] [Google Scholar]
  • 85.Fiscella K, Geiger HJ. Health information technology and quality improvement for community health centers. Health Aff. 2006 Mar;25(2):405–12. doi: 10.1377/hlthaff.25.2.405. [DOI] [PubMed] [Google Scholar]
  • 86.Jibaja-Weiss ML, Volk RJ, Kingery P, et al. Tailored messages for breast and cervical cancer screening of low-income and minority women using medical records data. Patient Educ Couns. 2003 Jun;50(2):123–32. doi: 10.1016/s0738-3991(02)00119-2. [DOI] [PubMed] [Google Scholar]
  • 87.Bodenheimer T, Grumbach K, Berenson RA. A lifeline for primary care. N Engl J Med. 2009 Jun;360(26):2693–6. doi: 10.1056/NEJMp0902909. [DOI] [PubMed] [Google Scholar]
  • 88.Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med. 2007 Sep;5(5):457–61. doi: 10.1370/afm.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 89.Mitchell R, Parker V, Giles M, et al. Toward Realizing the Potential of Diversity in Composition of Interprofessional Health Care Teams: An Examination of the Cognitive and Psychosocial Dynamics of Interprofessional Collaboration. Med Care Res Rev. 2009 Jul; doi: 10.1177/1077558709338478. 1077558709338478. [DOI] [PubMed] [Google Scholar]
  • 90.New York Department of HealthNew York Department of Health. Announcing New York Medicaid’s Statewide Patient-Centered Medical Home Incentive Program. [Google Scholar]
  • 91.National Committee for Quality AssuranceNational Committee for Quality Assurance. Draft Standards for Patient Centered Medical Home (PCMH) 2011. [Google Scholar]
  • 92.Collins F. Opportunities and challenges for the NIH--an interview with Francis Collins. Interview by Robert Steinbrook. N Engl J Med. 2009 Oct;361(14):1321–3. doi: 10.1056/NEJMp0905046. [DOI] [PubMed] [Google Scholar]
  • 93.Landon BE, Hicks LS, O’Malley AJ, et al. Improving the management of chronic disease at community health centers. N Engl J Med. 2007 Mar;356(9):921–34. doi: 10.1056/NEJMsa062860. [DOI] [PubMed] [Google Scholar]
  • 94.Breen N, Meissner HI. Toward a system of cancer screening in the United States: trends and opportunities. Ann Rev Public Health. 2005;26:561–82. doi: 10.1146/annurev.publhealth.26.021304.144703. [DOI] [PubMed] [Google Scholar]
  • 95.Sabatino SA, Habarta N, Baron RC, et al. Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers systematic reviews of provider assessment and feedback and provider incentives. Am J Prev Med. 2008 Jul;35(1:Suppl):Suppl-74. doi: 10.1016/j.amepre.2008.04.008. [DOI] [PubMed] [Google Scholar]
  • 96.Schenck AP, Peacock S, Pignone M, et al. Increasing colorectal cancer testing: translating physician interventions into population-based practice. Health Care Financ Rev. 2006;27(3):25–35. [PMC free article] [PubMed] [Google Scholar]
  • 97.Bach PB, Pham HH, Schrag D, et al. Primary care physicians who treat blacks and whites. N Engl J Med. 2004 Aug;351(6):575–84. doi: 10.1056/NEJMsa040609. [DOI] [PubMed] [Google Scholar]
  • 98.Hing ES, Burt CW, Woodwell DA. Electronic medical record use by office-based physicians and their practices: United States, 2006. Advance Data. 2007 Oct 26;(393):1–7. [PubMed] [Google Scholar]

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