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Kaiser also provides resources for healthy eating and has included exercise as a vital sign in its EMRs. Schottinger reported that the percentage of patients over 18 who smoke has declined significantly, to about 9 percent, and that has been accompanied by a decline in lung cancer incidence rates, which are well below national averages. In addition, their breast and cervical screening rates have consistently been above 90 percent, and colorectal cancer screening rates are around 80 percent, Schottinger reported. Presumably due to these screening efforts, fewer Kaiser Permanente members are being diagnosed with colorectal cancer at any stage (see Figure 9). From 2008 to 2011, the total incidence rate for colorectal cancer among Kaiser Permanente members declined by 36 percent.

Schottinger attributed Kaiser Permanente’s successful cancer prevention efforts in part to their extensive EMRs that notify practitioners if their patients are not up to date on proper screening tests, are smoking, or are not getting sufficient exercise, for example.

Evidence Base for Clinical Practice and Reimbursement

Several speakers noted there is a lack information on the comparative effectiveness of cancer care interventions that can guide clinical practice. Erwin said that clinical trials are generally designed for publication or for


FIGURE 9 Reduction in diagnoses of colorectal cancers at Kaiser Permanente, 2008–2011.

SOURCE: Schottinger presentation (October 9, 2012).

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