nity share responsibility for this aspect of efforts to improve the health status of women at risk for breast and cervical cancers.

Some of these data are tracked by state health departments and health plans. Overall, however, the ability to collect and analyze data for this indicator is somewhat troublesome, and therefore, it may be weak when standing alone. This indicator also may have limited sensitivity to changes in the performance of the system and may be difficult to track given the array of individuals, organizations, and institutions involved in educational programs.

Examples of performance indicators that could be used in communities are the following:

• Proportion of employers, community-based organizations, school parent-teacher associations (PTAs), or faith organizations that provided in the past 12 months health promotion programs in the community about the value of screening, breast self-exam, and the availability of screening programs to prevent breast and cervical cancer among women.

• For each health plan or insurer and the community as a whole, the proportion of women who have a risk factor for breast or cervical cancer that can be modified through lifestyle changes.

2. Availability of effective patient and family support programs.

In response to the American Cancer Society (1989) report Cancer and the Poor, hospitals that serve poor patients began to respond to their special needs (e.g., diagnosis at a later stage of disease, lack of insurance, unfamiliarity with negotiating the health care system) by developing expanded inner-city screening programs and innovative "patient navigator" programs. The patient navigator programs have proven effective as a mechanism for helping patients who receive an abnormal screening result complete a confirming biopsy and treatment in a timely manner (Freeman et al., 1995). Communities may want to duplicate such programs as a way of responding to the special needs of their medically underserved populations. Communities also may want to monitor the number of support programs for women and the utilization rate of such programs.

A proposed set of performance indicators is listed below. The