Medical care systems do a relatively poor job of delivering disease prevention interventions despite research studies showing that such interventions are effective. This program project focuses on the development and delivery of cost-effective smoking cessation programs, the establishment of a safety net system for breast and cervical cancer screening, and the testing of effective methods for involving employers in cancer prevention activities. It addresses the defined population base of a 375,000 member HMO and the dissemination of those interventions to other medical car systems. Medical care systems need to integrate effective cancer control activities into the delivery of care. This goal is achievable using a community intervention approach in which medical care systems are treated as communities. In the first four years of TRACC, five approaches to integrating smoking interventions into the medical care process were tested in randomized trials. This application takes the next logical step with two phase IV smoking projects and a phase III-IV screening project. The interventions are delivered to a defined population base through activities focused in hospitals, outpatient clinics, and UV direct mail. TRACC II also takes advantage of other resources inherent in prepaid group practice settings such as patient tracking systems and the opportunity for a population based, rather than patient-based, program is to reduce the prevalence of smoking and raise the incidence of smoking cessation among HMO members, and to assure that women do not exceed acceptable maximum intervals for screening for breast and cervical cancers. This program is generalizable directly to other HMOs, and most elements are applicable to any large medical organization. An explicit objective is to extend these interventions to other Kaiser Permanente regions and to support such extensions with cost effectiveness analyses of the implementation experiences.
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