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Interventions That Increase Use of Adult Immunization and Cancer Screening Services: A Meta-Analysis

Erin G. Stone, MD; Sally C. Morton, PhD; Marlies E. Hulscher, PhD; Margaret A. Maglione, MPP; Elizabeth A. Roth, MA; Jeremy M. Grimshaw, MD, PhD; Brian S. Mittman, PhD; Lisa V. Rubenstein, MD; Laurence Z. Rubenstein, MD; and Paul G. Shekelle, MD, PhD
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From the Southern California Evidence-Based Practice Center (which includes the RAND Health Division), Santa Monica, Cedars–Sinai Medical Center and the Greater Los Angeles Veterans Administration Health Care System, Los Angeles, and Center for the Study of Health Care Provider Behavior, Sepulveda, California; the University of Nijmegen, Centre for Quality of Care Research, Nijmegen, the Netherlands; and the University of Aberdeen, Health Services Research Unit, Aberdeen, Scotland, United Kingdom.

Note: The authors are responsible for the content of this report, and the views expressed are theirs alone. Statements in the report should not be construed as endorsement by the Centers for Medicare & Medicaid Services or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

Acknowledgments: The authors thank Preethi Srikanthan, MD, Walter Mojica, MD, MPH, Michael Hirt, MD, and Tommy Tomizawa, MD, for article abstraction; John Adams for statistical advice; Roberta Shanman for library searching; Brian Chao for database management; Shannon Rhodes and Jeri Jackson for secretarial assistance; and Pauline Lapin for continued support.

Grant Support: By a contract (500-98-0281 “Healthy Aging”) from the Centers for Medicare & Medicaid Services to RAND. The Health Services Research Unit is funded by the Chief Scientist Office, Scottish Executive Health Department. EPOC is funded by the National Health Service Research and Development Programme.

Requests for Single Reprints: Paul G. Shekelle, MD, PhD, RAND, 1700 Main Street, PO Box 2138, Santa Monica, CA 90407-2138; e-mail, shekelle@rand.org.

Current Author Addresses: Dr. Stone: Department of Urgent Care, Kaiser Permanente, 5601 De Soto Avenue, Woodland Hills, CA 91365.

Drs. Morton and Shekelle, Ms. Maglione, and Ms. Roth: RAND, 1700 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138.

Dr. Hulscher: Department of General Practice and Social Medicine, Centre for Quality of Care Research, Box 9101, 6500 HB Nijmegen, the Netherlands.

Dr. Grimshaw: Ottawa Health Research Institute, Clinical Epidemiology Programme, 1053 Carling Avenue, Ottawa, Ontario K1Y 4EY, Canada.

Drs. Mittman, L.V. Rubenstein, and L.Z. Rubenstein: Sepulveda Veterans Affairs Medical Center, Center for the Study of Health Care and Provider Behavior, 16111 Plummer Street, Sepulveda, CA 91343.

Author Contributions: Conception and design: S.C. Morton, M.E. Hulscher, M.A. Maglione, J.M. Grimshaw, B.S. Mittman, L.V. Rubenstein, L.Z. Rubenstein, P.G. Shekelle.

Analysis and interpretation of the data: E.G. Stone, S.C. Morton, B.S. Mittman, L.V. Rubenstein, L.Z. Rubenstein, P.G. Shekelle.

Drafting of the article: E.G. Stone, S.C. Morton, M.A. Maglione, P.G. Shekelle.

Critical revision of the article for important intellectual content: E.G. Stone, S.C. Morton, M.E. Hulscher, J.M. Grimshaw, L.V. Rubenstein, L.Z. Rubenstein, P.G. Shekelle.

Final approval of the article: E.G. Stone, M.E. Hulscher, B.S. Mittman, L.V. Rubenstein, L.Z. Rubenstein, P.G. Shekelle.

Provision of study materials or patients: E.G. Stone, M.E. Hulscher, J.M. Grimshaw.

Statistical expertise: S.C. Morton, P.G. Shekelle.

Obtaining of funding: L.Z. Rubenstein, P.G. Shekelle.

Administrative, technical, or logistic support: M.E. Hulscher, M.A. Maglione.

Collection and assembly of data: E.G. Stone, M.E. Hulscher, E.A. Roth, B.S. Mittman, P.G. Shekelle.

Ann Intern Med. 2002;136(9):641-651. doi:10.7326/0003-4819-136-9-200205070-00006
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Clinical managers, payers, and policymakers are responsible for improving preventive care for the patient populations they serve. The numerous high-quality health services research studies on interventions to improve preventive care represent an extraordinary resource for prevention improvement and demonstrate that improvement is feasible through various methods. The diverse types of interventions these studies used, however, leaves us with a compelling question: Which intervention approaches work best?

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Conceptual framework for assessing interventions to improve receipt of preventive services.
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Appendix Figure. *Because articles came from more than one source, the sum total of the numbers in parentheses do not equal the number of articles screened ( = 552). †Some articles described more than one unique study. NPDs = narrative project documents.
Literature sources for interventions to improve receipt of preventive services.n
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Summary for Patients

Ways To Deliver Preventive Health Care

The summary below is from the full report titled “Interventions That Increase Use of Adult Immunization and Cancer Screening Services: A Meta-Analysis.” It is in the 7 May 2002 issue of Annals of Internal Medicine (volume 136, pages 641-651). The authors are EG Stone, SC Morton, ME Hulscher, MA Maglione, EA Roth, JM Grimshaw, BS Mittman, LV Rubenstein, LZ Rubenstein, and PG Shekelle.


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