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Purpose: To evaluate an intervention promoting adoption of occupational sun protection policies by employers in a randomized trial., Design: A randomized pretest-posttest controlled design with 2-year follow-up was conducted in 2010 to 2013., Setting: Local government organizations in Colorado who had outdoor workers in public works, public safety, and/or parks and recreation., Participants: Ninety-eight local government organizations (n = 51 municipalities, 10 counties, and 37 special districts)., Intervention: Organizations were randomly assigned to receive a policy and education intervention comprised of personal contacts and theory-based training and materials or to an attention control group., Measures: Occupational policy documents were coded for sun safety content by a trained research assistant blind to condition., Analysis: Policy scores were analyzed with logistic and Poisson regression models using imputation., Results: At posttest, more organizations in the intervention group had a sun protection policy than in the control group (odds ratio [OR] = 4.91, P < .05; intent to treat: OR = 5.95, P < .05) and policies were more extensive (χ 2 = 31.29, P < .01; intent to treat: χ 2 =73.79, P < .01) and stronger (χ 2 = 24.50, P < .01; intent to treat: χ 2 = 51.95, P < .01). Policy adoption was higher when the number of contacts and trainings increased ( P < .05)., Conclusion: The intervention had a large effect on adoption of formal sun protection policies, perhaps because of its fit with legal requirements to maintain safe workplaces. Personal contacts with managers were influential on adoption of occupational policy even in this age of communication technology and social media.

Objective: There is a well-documented gap between diabetes care guidelines and the services received by patients in most health care settings. This report presents 12-month follow-up results from a computer-assisted, patient-centered intervention to improve the level of recommended services patients received from a variety of primary care settings., Research Design and Methods: A total of 886 patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program. Physicians were stratified and randomized to intervention or control conditions and evaluated on two primary outcomes: number of recommended laboratory screenings and recommended patient-centered care activities completed from the National Committee on Quality Assurance/American Diabetes Association Provider Recognition Program (PRP). Secondary outcomes were evaluated using the Problem Areas in Diabetes 2 quality of life scale, lipid and HbA1c levels, and the Patient Health Questionnaire-9 depression scale., Results: The program was well implemented and significantly improved both the number of laboratory assays and patient-centered aspects of diabetes care patients received compared with those in the control condition. There was overall improvement on secondary outcomes of lipids, HbA1c, quality of life, and depression scores; between-condition differences were not significant., Conclusions: Staff in small, mixed-payer primary care offices can consistently implement a patient-centered intervention to improve PRP measures of quality of diabetes care. Alternative explanations for why these process improvements did not lead to improved outcomes, and suggested directions for future research are discussed.

Objectives: We examined the effect of routine screening on breast cancer staging by race/ethnicity., Methods: We used a 1990 to 1998 mammography database (N = 5182) of metropolitan Denver, Colo, women to examine each racial/ethnic cohort's incident cancer cases (n = 1902) and tumor stage distribution given similar patterns of routine screening use., Results: Regardless of race/ethnicity, women participating in routine screenings had earlier-stage disease by 5 to 13 percentage points. After control for possible confounding factors, White women were more likely to have early-stage disease compared with Black and Hispanic women., Conclusions: Lack of screening coverage in certain racial/ethnic populations has often been cited as a reason for tumor stage differences at detection. In this study, correcting for screening did not completely reduce stage differentials among Black and Hispanic women.

Purpose: To assess possible changes in quality control (QC) practices at mammography sites in the United States., Materials and Methods: Mammography site surveys were conducted in 1990, 1992, and 1995 through the Colorado Mammography Advocacy Project (CMAP). Data from mammography sites applying for American College of Radiology (ACR) accreditation were collected between August 1987 and August 1993 through the ACR Mammography Accreditation Program. Data from both of these surveys were analyzed to assess temporal changes in mammography QC practices in the United States between 1987 and 1995., Results: CMAP results indicated statistically significant improvement in medical physicist QC practices between 1990 and 1992 and in technologist QC practices between 1990 and 1995. Improvements in radiologic technologist QC practices coincided with increases in radiologic technologist continuing education in mammography. ACR results indicated statistically significant improvement in technologist QC practices between 1988 and 1992., Conclusion: There have been substantial improvements in QC practices at mammography sites in the United States during the past decade.