Dartmouth Medical School (DMS) and Clinical Directors Network (CDN) are collaborating on the parent project to this supplement, which has been testing the impact of telephone support on the breast, cervical, and colorectal cancer screening of women who receive primary care from community health centers for the underserved in New York City. We are now ready to move forward with dissemination (Exhibit A-Letters of support). The parent project enrolled over 1,400 women age 50-69 years seen in 11 Community / Migrant Health Centers (C/MHCs) in a randomized controlled trial. Half of the women were assigned to receive telephone support services through Prevention Care Management (PCM), while the other half received usual care. Through a series of telephone calls, trained, quality-monitored Prevention Care Managers have used a manualized approach to provide knowledge to women about overdue screening tests, helped women overcome barriers to obtaining needed services, and provided follow up support. Our methods paper is in revision. Current preliminary analyses show a positive impact of the PCM intervention on screening for all three cancers. For example, colorectal cancer screening rates increased almost 100% over baseline with PCM. On the strength of our efficacy data, we propose to disseminate the PCM intervention to a priority subgroup of women-those enrolled with Medicaid managed care organizations and overdue for screening-using a practical approach to enhance their care that will be sustainable in real-world settings without research support. The parent project relied on research staff closely supervised by research investigators. Patients were identified, recruited and consented through an intensive research-driven process. In this supplement, tha parent project team will work with Affinity Health Plan, a Medicaid managed care organization (MMCO), so that Affinity develops the capacity for, provides and sustains the PCM intervention to covered women guided by Diffusion of Innovations theory. The PCM intervention, promoting screening for breast, cervical and colorectal cancer as recommended by the US Preventive Services Task Force (USPSTF), is the innovation under consideration. PCM is an enhancement to the process of care, i.e. the sequence of events by which patients obtain cancer screening. As additional sequence of events is important to distinguish at the outset of this proposal: the process of change by which PCM is implemented within the Affinity MMCO context and elsewhere. This supplement will allow study of dissemination of the PCM innovation at three levels: 1. Individuals-Affinity covered women assigned to the PCM intervention (a process of care); 2. The organization-the affinity MMCO itself, that with initial assistance from the parent project will implement and reinvent PCM to be sustainable (a process of change); 3. And other regional MMCOs and community health centers that are not participating in this supplement- as results from our parent project and dissemination work proposed here are presented and these organizations consider implementing PCM (a process of change).
