The goal of this project is to establish a coordinated cancer control and research program which targets the needs of a traditionally underserved, inner-city minority population within the context of an existing primary care structure. The project objectives are to increase by an absolute 20 percent the target populations's use of screening mammography, Pap smear and prostatic examinations. The project will a) establish accessible and reduced-cost cervical cytology, colposcopy and mammography units, b) prompt procedure-due patients (via mailed notices) to visit a primary care study site, c) prompt physicians (via the patient's medical record) to offer visiting patients procedures for which they are due, and d) facilitate the active follow-up (by on-site follow up coordinators) of patients requiring additional cancer-related diagnostic or therapeutic services. The computerbased information management system which supports the prompting activities is an extension of a currently operational system which has successfully increased the use of screening mammography in three of the study sites. Project activities will represent the coordinated efforts of the Detroit Health Department (4 sites) and Comprehensive Health Services (an HMO) (2 sites), the Michigan Cancer Foundation, Wayne State University, the Detroit Medical Center, and the Meyer L. Prentis Comprehensive Cancer Center of Detroit. Patient enrollment will exceed 10,000 in year 1 and will rise to 18,000 in year 3. In five of the six sites over 85% of patients are black and in the sixth 20% are black, 34% are Hispanic, and 46% are other. The project's primary research aims will be addressed in four series of randomized, clinical trials. These will evaluate the initial and sustained effectiveness of an information management system which: 1) adds patient visit prompting to physician for mammography, 2) prompts patients and physicians to accomplish cytology, and 3) prompts physicians to perform rectal (prostatic) fourth trial will evaluate in six study sites the coordinated prompts patients and physicians to accomplish each appropriate compare alternative health care organizations (Health Department and target populations. Secondary and sub-group analyses will examine the effectiveness of individual intervention components, patient perceived barriers to the intervention, and the impact of the special units on procedure use.
