Department of Family Medicine and Community Health; Department of Medicine, Division of Hematology/Oncology; Department of Medicine, Division of Preventive and Behavorial Medicine; Center for Health Policy and Research
Mammography; Early Detection of Cancer; Mass Screening; Patient Compliance; Patient Education as Topic; Marketing of Health Services
Health Services Administration | Health Services Research | Public Health
BACKGROUND: Despite the demonstrated need to increase screening mammography utilization and strong evidence that mail and telephone outreach to women can increase screening, most managed care organizations have not adopted comprehensive outreach programs. The uncertainty about optimum strategies and cost effectiveness have retarded widespread acceptance. While 70% of women report getting a mammogram within the prior 2 years, repeat mammography rates are less than 50%. This 5-year study is conducted though a Central Massachusetts healthcare plan and affiliated clinic. All women have adequate health insurance to cover the test.
METHODS/DESIGN: This randomized study compares 3 arms: reminder letter alone; reminder letter plus reminder call; reminder letter plus a second reminder and booklet plus a counselor call. All calls provide women with the opportunity to schedule a mammogram in a reasonable time. The invention period will span 4 years and include repeat attempts. The counselor arm is designed to educate, motivate and counsel women in an effort to alleviate PCP burden.All women who have been in the healthcare plan for 24 months and who have a current primary care provider (PCP) and who are aged 51-84 are randomized to 1 of 3 arms. Interventions are limited to women who become >/=18 months from a prior mammogram. Women and their physicians may opt out of the intervention study.Measurement of completed mammograms will use plan billing records and clinic electronic records. The primary outcome is the proportion of women continuously enrolled for >/=24 months who have had >/=1 mammogram in the last 24 months. Secondary outcomes include the number of women who need repeat interventions. The cost effectiveness analysis will measure all costs from the provider perspective.
DISCUSSION: So far, 18,509 women aged 51-84 have been enrolled into our tracking database and were randomized into one of three arms. At baseline, 5,223 women were eligible for an intervention. We anticipate that the outcome will provide firm data about the maximal effectiveness as well as the cost effectiveness of the interventions both for increasing the mammography rate and the repeat mammography rate.
TRIAL REGISTRATION: http://clinicaltrials.gov/NCT01332032.
Rights and Permissions
© 2011 Costanza et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI of Published Version
BMC Health Serv Res. 2011 Jun 3;11:145. Link to article on publisher's site
BMC health services research
Costanza ME, Luckmann RS, White MJ, Rosal MC, Cranos C, Reed GW, Clark RE, Sama S, Yood RA. (2011). Design and methods for a randomized clinical trial comparing three outreach efforts to improve screening mammography adherence. Center for Health Policy and Research (CHPR) Publications. https://doi.org/10.1186/1472-6963-11-145. Retrieved from https://escholarship.umassmed.edu/healthpolicy_pp/64