3128.0: Monday, November 13, 2000 - 2:50 PM

Abstract #9862

Guideline formulation and monitoring in HMOs: The case of breast cancer screening

Jane G. Zapka, ScD1, Karin Valentine Goins, MPH1, Stephen Taplin, MD, MPH2, and Ann M. Geiger, PhD3. (1) Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, (508) 856-5675, jane.zapka@umassmed.edu, (2) Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, (3) Research and Evaluation Department, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91188

Clinical practice guidelines are viewed by plans, purchasers and consumers as an important vehicle for promoting best practices and improving plan performance. Breast cancer screening is used in a case study to examine organizational adoption and implementation of guidelines in seven health maintenance organizations. Current guidelines were collected in Fall 1999. Document content analysis and key informant interviews were conducted in Winter 1999-2000. Guideline formulation (process, participants) and dissemination (targets, methods) are described. The content analysis results comparing and contrasting the guidelines according to screening modality (mammography, clinical breast exam, self-exam), risk determination, member characteristics, periodicity, and surveillance are reviewed. Existing policies and protocols (reminder systems, tracking systems) at the plan and medical group levels, which are related to clinician action, are described. Quality control reports and other monitoring strategies are compared. The analysis found that while all plans had explicit guidelines, the process of development varied, ranging from adoption of existing guidelines to lengthy deliberation by interdisciplinary committees. The format and clarity of the guidelines varied widely, but the essential content was strikingly similar, and the dissemination processes fairly consistent. Variability in policies and procedures to support implementation, as well as routine monitoring strategies, was documented. Trends in variability of the procedures according to plan structure (e.g., size, contractual arrangements) were not evident. The relationship of these activities to HEDIS performance reports is discussed. The impact of implementation processes on plan performance needs closer evaluation.

Learning Objectives: At the conclusion of this session, the participant will be able to: 1. Describe a process that can be used for comparison of clinical practice guidelines. 2. Articulate how different approaches to guideline implementation may contribute to differences in cancer screening in managed care organizations. 3. List several mechanisms by which managed care plans monitor adherence to guidelines

Keywords: Cancer Screening, Managed Care

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: 7 health maintenance organizations (HMOs)
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA