Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates

Am J Manag Care. 2004 Apr;10(4):265-72.


Background: Despite the importance of early cancer detection, variation in screening rates among physicians is high. Insights into factors influencing variation can guide efforts to decrease variation and increase screening rates.

Objectives: To explore the association of primary care practice features and a facility's quality orientation with breast and cervical cancer screening rates.

Study design: Cross-sectional study of screening rates among 144 Department of Veterans Affairs (VA) medical centers and for a national sample of women.

Methods: We linked practice structure and quality improvement characteristics of individual VA medical centers from 2 national surveys (1 to primary care directors and 1 to a stratified random sample of employees) to breast and cervical cancer screening rates determined from a review of random medical records. We conducted bivariate analyses and multivariate logistic regression of primary care practice and facility features on cancer screening rates, above and below the median.

Results: While the national screening rates were high for breast (87%) and cervical cancer (90%), higher screening rates were more likely when primary care providers were consistently notified of specialty visits and when staff perceived a greater organizational commitment to quality and anticipated rewards and recognition for better performance.

Conclusions: Organization and quality orientation of the primary care practice and its facility can enhance breast and cervical cancer screening rates. Internal recognition of quality performance and an overall commitment to quality improvement may foster improved prevention performance, with impact varying by clinical service.

Publication types

  • Comment
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Breast Neoplasms / diagnosis*
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence / statistics & numerical data
  • Health Services Research
  • Humans
  • Logistic Models
  • Mammography / standards
  • Mammography / statistics & numerical data
  • Mass Screening / methods
  • Mass Screening / standards
  • Mass Screening / statistics & numerical data*
  • Multivariate Analysis
  • Organizational Culture
  • Organizational Policy
  • Physician Incentive Plans / organization & administration
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Predictive Value of Tests
  • Primary Health Care / organization & administration*
  • Quality Assurance, Health Care / organization & administration*
  • United States
  • United States Department of Veterans Affairs
  • Uterine Cervical Neoplasms / diagnosis*
  • Vaginal Smears / standards
  • Vaginal Smears / statistics & numerical data