Cancer screening in HMOs: program development and evaluation.

Introduction: In many clinical settings, effective cancer control is hampered by barriers related to the acute-care orientation of most medical practices. These include: prioritization of medical problems on the basis of urgency; a problem-oriented medical record that provides no ongoing documentation mechanism for cancer screening; conflicting guidelines; and no method for identifying and targeting persons who are eligible for screening. In contrast, HMOs are uniquely suited to deliver effective cancer control as they have already established many of the linkages required for successful primary and secondary prevention.
Methods: This paper describes the principles of a population-based approach to cancer prevention and draws on the experience of Group Health Cooperative of Puget Sound, an HMO in western Washington with more than 20 years' experience in prevention and centralized cancer screening. Methods for selecting and determining priorities among cancer prevention issues, components of successful screening programs, and measures of short- and long-term evaluation are discussed through examples of screening for breast, prostate, cervix, and colorectal cancers.
Conclusions: HMOs have provided leadership in the integration of health services and the promotion of continuity of care. Using a population-based approach, cancer prevention programs may be supported by existing automated information services to reduce morbidity and mortality through early detection.